急性等容血液稀释对单次插管剂量顺式阿曲库铵作用时效的影响  

Effect of acute normovolemic hemodilution on the onset-dutat ion-recovery profile of cisatracurium

作　　者：余亮[1] 汪卫星[1] 何焕钟[1] 周惠芬[1] 胡四平[1] 刘洋[1] 

机构地区：[1]湖州市中心医院麻醉科,浙江湖州313000

出　　处：《上海医学》2012年第8期659-662,共4页Shanghai Medical Journal

摘　　要：目的探讨急性等容血液稀释(ANH)对单次插管剂量3倍95%有效药物剂量的顺式阿曲库铵肌肉松弛作用时效的影响。方法将40例行择期手术的患者随机分为ANH组和对照组,每组20例。ANH组麻醉诱导前行ANH,对照组未做特殊处理。记录两组患者人手术室后即刻及ANH组实施ANH后的红细胞比容(Hct)、血红蛋白(Hb)、电解质(K^+、Na^+、Ca^(2+))、清蛋白、总蛋白水平,应用肌肉松弛监测仪监测顺式阿曲库铵的肌肉松弛起效时间、无反应期、阻滞维持时间、肌肉松弛恢复时间和恢复指数,同时记录气管插管条件。结果两组患者人手术室后即刻的Hct、Hb、K^+、Na^+、Ca^(2+)、清蛋白、总蛋白水平的差异无统计学意义(P值均>0.05);ANH组患者实施ANH后的Hct、Hb、K^+、Na^+、Ca^(2+)、清蛋白、总蛋白水平较本组人手术室后即刻显著下降(P值均<0.05),但基本在正常生理范围内。ANH组的肌肉松弛起效时间显著短于对照组(P<0.05),两组间无反应期、阻滞维持时间、肌肉松弛恢复时间和恢复指数的差异均无统计学意义(P值均>0.05)。两组间气管插管条件的差异无统计学意义(P>0.05)。ANH组的异体血输血率显著低于对照组(P<0.05)。结论 ANH能缩短单次插管剂量的顺式阿曲库铵的肌肉松弛起效时间,对无反应期、阻滞维持时间、肌肉松弛恢复时间和气管插管条件无明显影响。Objective To investigate the effect of acute normovolemic hemodilution （ANH） on the onset- duration-recovery profile of three times 95% effective dosage （3 x ED95 ） of cisatracurium in patients undergoing surgical treatment. Methods Forty patients scheduled for selective operation were randomized into ANH group and control group （n = 20）. The patients in the ANH group underwent ANH before anesthesia induction. Blood samples were taken for the measurement of hematocrit （Hct）, hemoglobin （Hb）, electrolytes （K^＋ , Na^＋ , and Ca^2＋ ）, albumin （AIb） and total protein （TP） before operation and after ANH. Meanwhile the onset time of muscle relaxation, peak effect time, duration of nerve block, recovery time, recovery index and intubation conditions were monitored. Results There were no significant differences in terms of Hct, Hb, K^＋ , Na^＋ , Ca^2＋ , AIb, and TP between the two groups when the patients entered the operation room （P〉0.05）. The Hct, Hb, K^＋ , Na^＋ , Ca^2＋, AIb, and TP were significantly decreased after ANH in the patients with ANH （P〈0. 05）, but these physiological parameters were still in the normal range. The onset time in the ANH group was significantly shorter than that in control group （P〈0.05）. There was no significant difference in peak effect time, duration of nerve block, recovery time, recovery index and intubation conditions between the two groups （P〉 0. 05）. The percentage of allogeneic blood transfusion in the ANH group was significantly lower than that in the control group （P〈0. 05）. Conclusion ANH can shorten the onset time of cisatracurium during the anesthesia. But ANH is not correlated with the peak effect time, duration of nerve block, recovery time or intubation conditions. （Shanghai Med J, 2012, 35; 659-662）

关 键 词：血液稀释 自体 输血 顺式阿曲库铵 

分 类 号：R614[医药卫生—麻醉学]