预注不同小剂量罗库溴铵对耳鼻喉科手术患者应用米库氯铵药效的影响  

Effects of priming different low-dose rocurium on pharmacodynamics of mivacurium

作　　者：辛燕[1] 郭英[1] 姜雨鸽[1] 张宏[1] 

机构地区：[1]解放军总医院麻醉手术中心,北京100853

出　　处：《中华医学杂志》2014年第21期1647-1650,共4页National Medical Journal of China

摘　　要：目的研究预注不同剂量罗库溴铵对米库氯铵药效的影响。方法选择解放军总医院耳鼻喉科2013年3至9月拟行手术患者120例，经医院伦理委员会审核通过，其亲属签署知情同意书并采用随机数字表法随机均分为4组：Ⅰ组为空白对照组，预注3ml生理盐水，Ⅱ组、Ⅲ组、Ⅳ组分别预注罗库溴铵0．06、0．075、0．1mg／kg，3min后给予插管剂量米库氯铵0．15mg／kg，记录米库氯铵的起效时间和插管时间、T125％和75％恢复时间、肌张力恢复至T4／T1分别为25％、75％和90％时的时间及恢复指数，以及评价插管条件。结果与Ⅰ组起效时间（280±88）s相比，3个实验组（Ⅱ组、Ⅲ组和Ⅳ组）的起效时间分别为（149±45）、（146±60）、（140±38）s，且明显缩短46．81％、47．75％、49．88％（P〈0．01），但3个实验组随着预注剂量的增加，米库氯铵的起效时间差异无统计学意义。与Ⅰ组相比，3个实验组的无反应期延长（P〈0．01），T1恢复到25％和75％的时间延长（P〈0．01或P〈0．05），但其恢复指数并不增加（P=0．13）。结论预注小剂量罗库溴铵能明显缩短米库氯铵的起效时间，而对其作用没有明显影响。3个预注剂量间的药物作用没有明显差异。Objective To explore the effects of priming rocuronium on neuromuscular blockade produced by mivacurium. Methods Ethical approval was granted by the medical ethics committee of our hospital with a reference number of C-2013-018-01. A total of 120 ASA physical status I and II patients undergoing selective otorhinolaryngologic surgery under general anesthesia signed the form of informed consent. And they were randomly divided by a random number table into 4 groups. After a standardized imidazole-propofol-fentanyl induction, they received a saline placebo injection （Group I ） and a priming dose of rocuronium 0. 06 mg/kg （ Group II ） , rocuronium 0. 075 mg/kg （ Group III ） and rocuronium 0. 1 mg/kg （Group IV ）. An intubating dose of mivacurium 0. 15 mg/kg was offered 3 minutes later. Anesthesia was maintained with propofol and remifentanyl continuous infusion. Neuromuscular block was monitored with train of four （TOF） stimulation. The onset time, reappearance of T1 （DUR TOFc 1 ） , times of T1 25% and 75% recovery, recovery index and times of TOF25% , 75% and 90% recovery were recorded. Results The onset time of mivacurium was significantly shorter and the times of T1 25% and 75% recovery were significantly longer in groups of II , III and IV than those in group I. No significant difference existed in recovery index among 4 groups. The onset time of mivacurium became progressively shorter with the growing pri ruing dose of rocurium among three experiment groups. And it was not statistically significant. Conclusions Priming rocuronium decreases the onset and intubating times of mivacurium without effect on recovery index. No significant difference exists in drug effect among 3 experiment groups.

关 键 词：米库氯铵 罗库溴铵 神经肌肉阻滞 预注法 

分 类 号：R614[医药卫生—麻醉学]