顺式阿曲库铵在发热患者体内的药效学研究  

Pharmacodynamic study of cisatracurium in patients with fever

作　　者：陈念平[1] 李玉红[1] 谢凯[1] 胡双燕[1] 郑羡河[1] 金宝伟[1] 

机构地区：[1]绍兴市人民医院麻醉科,浙江绍兴312000

出　　处：《上海医学》2013年第8期702-705,共4页Shanghai Medical Journal

基　　金：浙江省医学会临床科研基金(2011ZYC-A88);浙江省钱江人才计划项目(2012R10033)资助

摘　　要：目的观察发热对顺式阿曲库铵肌肉松弛效应的影响。方法选择全身麻醉下行腹腔镜下阑尾切除手术的患者60例,年龄20～50岁,美国麻醉医师学会(ASA)分级Ⅰ或Ⅱ级。其中发热(体温37.5～39.0℃)的单纯性或化脓性阑尾炎患者40例,据随机数字表将患者随机分入发热阿曲库铵0.15组和发热阿曲库铵0.20组;体温正常的20例阑尾炎患者作为对照进入对照阿曲库铵0.15组。麻醉诱导用药为咪达唑仑0.05mg/kg、丙泊酚1.5mg/kg、芬太尼5μg/kg,患者意识消失后,发热阿曲库铵0.15组和对照阿曲库铵0.15组均经静脉注射顺式阿曲库铵0.15mg/kg,发热阿曲库铵0.20组予静脉注射顺式阿曲库铵0.20mg/kg。记录3组患者顺式阿曲库铵的起效时间、临床作用时间、恢复指数,以及气管插管评级和不良反应情况。结果发热阿曲库铵0.15组和发热阿曲库铵0.20组顺式阿曲库铵的起效时间、临床作用时间均显著短于对照阿曲库铵0.15组(P值分别<0.01、0.05),恢复指数均显著小于对照阿曲库铵0.15组(P值均<0.05);发热阿曲库铵0.20组顺式阿曲库铵的起效时间显著短于发热阿曲库铵0.15组(P<0.05)。发热阿曲库铵0.15组和发热阿曲库铵0.20组的气管插管评级均显著优于对照阿曲库铵0.15组(P值分别<0.05、0.01)。3组患者用药期间均未发生明显不良反应。结论发热患者顺式阿曲库铵的起效时间、临床作用时间较体温正常患者明显缩短,恢复指数明显减小;适当增大剂量可明显缩短发热患者顺式阿曲库铵的起效时间,但并不影响临床作用时间。Objective To investigate the influence of fever on the neuromuscular block induced by cisatracurium. Methods Sixty patients with appendicitis, aged 20 to 50 years old, American Society of Anesthesiologists （ASA） Ⅰ or Ⅱ, undergoing laparoscopic surgery under general anesthesia were enrolled in the present study. According to random number table, forty of them （body temperature 37.5--39.0 ℃ ） with simple or suppurative appendicitis were randomly divided into group A and group B. The rest 20 patients with normal body temperature were allocated into control group. Anesthesia was induced with midazolam 0. 05 mg/kg, propofol 1.5 mg/kg and fentanyl 5 μg/kg. When the patients became unconscious, cisatracurium （0. 15, 0. 20 and 0.15 mg/kg） were intravenously injected in the group A, group B and control group. The onset time, recovery time, clinical effect index, endotracheal intubation conditions and adverse reactions were observed and recorded. Results The onset time, recovery time and clinical effect index of cisatracurium in the two fever groups were significantly shorter than those in the control group （P〈0. 01, 0.05）. The onset time of cisatracurium in group B was significantly shorter than that in group A （P〈0.05）. Tracheal intubation conditions in the two fever groups was significantly better than that in the control group （P〈0.05, 0.01 ）. No obvious adverse reactions were found in the patients during treatment. Conclusion The onset time, recovery time and clinical effect index of cisatracurium in the patients with fever are significantly shorter than those with normal body temperature. When the dosage of cisatracurium is increased, the onset time of cisatracurium in patients with fever can be reduced, but the clinical recovery time will not be affected. （Shanghai Med J, 2013, 36： 702-705）

关 键 词：发热 顺式阿曲库铵 药效学 

分 类 号：R614[医药卫生—麻醉学]