罗库溴铵预处理对琥珀胆碱引起的肌痛、血钾升高和气管插管条件的影响  

Effects of rocuroium pretreatment on succinylcholine-induced myalgia,hyperkalemia and tracheal intubation

作　　者：徐文庆[1,2] 徐威[1] 

机构地区：[1]复旦大学附属金山医院麻醉科,上海200540 [2]上海市金山区亭林医院麻醉科

出　　处：《上海医学》2014年第4期300-303,共4页Shanghai Medical Journal

摘　　要：目的观察罗库溴铵预处理对琥珀胆碱引起的肌痛、血钾升高的预防作用,及其对气管插管条件的影响。方法选择100例择期采用静吸复合麻醉在显微喉镜下行声带手术的患者,年龄26~65岁,美国麻醉医师学会分级Ⅰ或Ⅱ级,随机分入对照组和研究组,每组50例。两组患者均静脉注射芬太尼2μg/kg、丙泊酚2mg/kg、琥珀胆碱1.5mg/kg行麻醉诱导,研究组患者在注射丙泊酚前加注罗库溴铵0.06mg/kg。气管插管后,两组患者均吸入七氟烷和静脉间断注射丙泊酚、琥珀胆碱10~20mg维持麻醉。罗库溴铵与琥珀胆碱的注射时间相隔1.5min,琥珀胆碱给药后1min行气管插管。分别于麻醉诱导前和气管插管后10min测定血钾和血钙浓度。观察注射琥珀胆碱后的肌纤维成束收缩程度和气管插管条件。记录琥珀胆碱的用量。术后24h随访患者的肌痛发生情况。结果研究组的肌纤维成束收缩发生率为56%（28/50）,显著低于对照组的96%（48/50,P〈0.01）,研究组肌纤维成束收缩的严重程度显著低于对照组（P〈0.01）。研究组的气管插管条件显著差于对照组（P〈0.05）。研究组的术后肌痛发生率和严重程度有低于对照组的趋势,但两组间的差异无统计学意义（P〉0.05）。对照组麻醉诱导后的血钾浓度显著高于同组麻醉诱导前（P〈0.05）,研究组麻醉诱导前后血钾浓度的差异无统计学意义（P〉0.05）。两组麻醉诱导后的血钙浓度均显著低于同组麻醉诱导前（P值均〈0.05）。对照组和研究组的琥珀胆碱用量的差异无统计学意义（P〉0.05）。患者的肌纤维成束收缩与术后肌痛无关联（P〉0.05）。结论罗库溴铵预处理能减轻琥珀胆碱所引起的肌纤维成束收缩,预防血钾浓度上升,但降低气管插管条件,术后肌痛发生率和严重程度有下降的趋势。Objective To observe the effects of rocuroium pretreatment on succinylcholine-induced myalgia, hyperkalemia and tracheal intubation conditions. Methods One hundred patients scheduled for vocal cord surgery through suspension laryngoscopy were divided into control group and research group randomly （n = 50）. The age of the patients ranged from 26 to 65 years and the assessment of American Society of Anesthesiologists （ASA） was grade I or II. Anesthesia induction was conducted with fentanyl 2 μg/kg, propofol 2 mg/kg and succinylcholine 1. 5 mg/kg. Patients in the research group were pretreated with rocuroium 0.06 mg/kg. The anesthesia was maintained with sevoflurane, propofol and succinylcholine （10- 20 mg）. There was an interval of 1. 5 minutes between the injection of rocuroium and succinylcholine. Succinylcholine was administered 1 minute before endotracheal intubation. Serum potassium and calcium concentrations were measured before induction and 10 minutes after intubation. The condition of intubation and fasciculations were observed. The consumption of succinylcholine was recorded. Myalgia was assessed at 24 hours postoperatively. Results The incidence of fasciculation in the research group was significantly lower than that in the control-group （56% vs. 96%, P〈0.01 ）, so was the severity of fasciculation （P〈0.01）. Tracheal intubation condition in the control group was superior to that in the research group （P〈0.05）. There were no significant differences in the incidence or severity of myalgia between two groups （P〉0.05）. The serum potassium level was increased significantly after induction in the control group （P〈0.05）, but in the research-group there was no significant difference in serum potassium level before or after induction （P〉0.05）. The serum was calcium decreased significantly after induction in all patients （both P〈0.05）. The consumption of succinylcholine was similar in the two groups （P〉0.05）. The fasciculation was not related to postopera

关 键 词：琥珀胆碱 罗库溴铵 预处理 肌纤维成束收缩 术后肌痛 

分 类 号：R614[医药卫生—麻醉学]