顺式阿曲库铵肌松效应及恢复过程的临床药效学观察  

Clinical pharmacodynamics of muscle relaxation effect of cisatracurium and post-operative reversal

作　　者：王灿琴[1] 王中云[1] 潘寅兵[1] 

机构地区：[1]南京医科大学第一附属医院麻醉科,江苏南京210009

出　　处：《实用临床医药杂志》2012年第7期36-38,共3页Journal of Clinical Medicine in Practice

摘　　要：目的观察顺式阿曲库铵单次静注肌松效应及术后恢复的临床药效学指标,并与阿曲库铵进行对照。方法 ASAⅠ、Ⅱ级全麻择期腹腔镜下胆囊摘除手术90例,随机分为CisⅠ组,CisⅡ组和Atc组。3组分别单次静注Cis 0.10mg/kg(2倍ED95,95%有效药物剂量),0.15 mg/kg和Atc 0.5 mg/kg。每组30例,每组再分别按肌松自主恢复、T110%拮抗及T125%拮抗分组,共9组(CisⅠ1、CisⅠ2、CisⅠ3;CisⅡ1、CisⅡ2、CisⅡ3及Atc1、Atc2、Atc3),每组10例。拮抗方法为静注新斯的明50μg/kg、阿托品10μg/kg。用TOF-2 Watch SX加速度仪进行肌松监测。记录各组的起效时间、插管条件、T125%、T190%恢复时间和TOF0.8的恢复时间。结果 CisⅠ组起效时间明显慢于CisⅡ组及Atc组,(分别为5.61±1.13、2.58±1.10、4.06±1.12,P<0.05)。3组的插管条件及最大阻滞程度无显著性差异;CisⅠ1、CisⅡ1、Atc1组90%恢复时间、TOF 0.8恢复时间均长于各自的CisⅠ2、CisⅡ2、Atc2及CisⅠ3、CisⅡ3、Atc3组,差别显著(P<0.05)。结论麻醉诱导时用2倍ED95顺式阿曲库铵可提供满意的插管条件;新斯的明可有效缩短肌松时间,且肌松恢复时间与肌松药剂量及拮抗时机无关。Objective To observe the clinical pharmacological indexes of single vein injection of cisatracurium（Cis）-induced neuromuscular blockade and postoperative reversal and compare it with atracurium（Atc）.Methods A total of 90 ASA Ⅰ-Ⅱ patients undergoing selective surgery were randomly allocated into three groups： Cis1（n=30）,Cis2（n=30） and Atc（n=30）.Cis 0.10 mg/kg（2×ED95）,0.15 mg/kg（3×ED95） or Atc 0.5 mg/kg（2×ED95） were administered respectively.Each group was subdivided into nine subgroups according to the spontaneous reversal of neuromuscular blockade,T1 10% and T1 25%（Cis Ⅰ1,CisⅠ2,CisⅠ3;CisⅡ1,CisⅡ2,CisⅡ3;Atc1,Atc2,Atc3）.Each subgroup had 10 patients.Antagonistic method consisted of intravenous injection of neostigmine（50 μg/kg） and atropine（10 μg/kg）.TOF-2 Watch SX was employed for monitoring muscle relaxation.The onset time,intubation conditions,reversal time of T1 25%,T1 90% and TOF 0.8 were recorded.Results The onset time of group CisⅠwas significantly shorter than that of groups CisⅡ and Atc.There were no significant differences in intubation conditions and maximum block effects between the three groups.Reversal time of T1 90% and TOF 0.8 in groups CisⅠ1,CisⅡ1,Atc1 was significantly shorter than that of groups CisⅡ2,Atc2,Cis Ⅰ3,CisⅡ3 and Atc3（P0.05）.Conclusion Cisatracurium 0.10 mg/kg（2×ED95） could provide acceptable intubation conditions of general anesthesia.Administration of neostigmine can significantly shorten the time of neuromuscular block,which,however,the reversal time does not related to the dose of muscle relaxant and antagonistic timing.

关 键 词：顺式阿曲库铵 阿曲库铵 肌松 

分 类 号：R971.7[医药卫生—药品]