低温体外循环对心内直视手术患者罗库溴铵肌松作用的影响  

Effects of hypothermic cardiopulmonary bypass on rocuronium-induced neuromuscular blockade in patients undergoing open heart surgery

作　　者：石伟东[1] 王宏亮[1] 李海波[1] 刘军[1] 李文志[1] 

机构地区：[1]哈尔滨医科大学附属第二医院麻醉科,150086

出　　处：《中华麻醉学杂志》2014年第10期1227-1230,共4页Chinese Journal of Anesthesiology

基　　金：黑龙江省卫生厅科研基金（2006-129）

摘　　要：目的 评价低温体外循环（CPB）对心内直视手术患者罗库溴铵肌松作用的影响.方法 择期行房间隔缺损缝合术或修补术患者20例,年龄18 ～ 45岁,体重指数18 ～ 25 kg/m2,性别不限,ASA分级Ⅰ级或Ⅱ级,采用随机数字表法,将其分为2组（n=10）：常温组（N组）和低温组（H组）.H组CPB期间维持鼻咽温30～31℃,N组CPB期间维持鼻咽温36 ～ 37℃,2组CPB前后维持鼻咽温36～37℃.静脉注射依托咪酯0.3 mg/kg、芬太尼2～4μg/kg和罗库溴铵0.3 mg/kg麻醉诱导,气管插管后机械通气,麻醉维持：静脉输注芬太尼25 μg·kg^-1·h^-1,间断静脉注射咪达唑仑0.04 μg/kg和芬太尼4 μg/kg,维持BIS值40～60.采用四个成串刺激监测拇内收肌肌颤搐,波宽为0.2 ms,频率为2 Hz,电流强度为40mA,刺激间隔为12 s,采用罗库溴铵自动化反馈控制给药系统静脉输注罗库溴铵,维持T18％～12％.分别于手术开始后10 min、CPB开始后10 min及CPB结束后10 min时采集动脉血样4ml,采用高效液相色谱法测定血浆罗库溴铵浓度,记录CPB前、CPB中和CPB后罗库溴铵的输注速率及其用量.结果 与N组比较,H组CPB开始后10 min及CPB结束后10 min时罗库溴铵血药浓度降低,CPB中和CPB后罗库溴铵输注速率及其用量降低（P＜0.05）.结论 低温CPB强化了心内直视手术患者罗库溴铵的肌松作用.Objective To evaluate the effects of hypothermic cardiopulmonary bypass （CPB） on rocuronium-induced neuromuscular blockade in the patients undergoing open heart surgery.Methods Twenty ASA physical status Ⅰ or Ⅱ patients,scheduled for elective open heart surgery,aged 18-45 yr,with body mass index of 18-25 kg/m2,were randomly assigned into 2 groups （n =10 each） using a random number table：room temperature group （group R） and hypothermia group （group H）.The nasopharyngeal temperature was maintained at 30-31 ℃ during CPB in group H or at 36-37 ℃ during CPB in group R,and it was maintained at 36-37 ℃ before and after CPB in both groups.Anesthesia was induced with iv etomidate 0.3 mg/kg,fentanyl 2-4 μg/kg and rocuronium 0.3 mg/kg.The patients were tracheally intubated and mechanically ventilated.Anesthesia was maintained with iv infusion of sufentanil and intermittent iv boluses of midazolam and fentanyl.BIS value was maintained at 40-60.Neuromuscular block was monitored using TOF-WATCH SX accelerometer.Train-of-four stimulation （intensity 40 mA,frequency 2 Hz,wave length 0.2 ms,interval 12 s） of ulnar nerve was used.Rocuronium was infused intravenously using an automatic feedback control system to maintain T1 at 8%-12%.At 10 min after start of operation （T0）,10 min after onset of CPB （T1）,and 10 min after termination of CPB,blood samples were collected for determination of the plasma concentration of rocuronium （by HPLC）.The infusion rate and consumption of rocuronium were recorded before,during and after CPB.Results Compared with group R,the plasma concentration of rocuronium was significantly decreased at T1,2,and the infusion rate and consumption of rocuronium were decreased before and after CPB in group H.Conclusion Hypothermic CPB enhances rocuroniuminduced neuromuscular blockade in the patients undergoing open heart surgery.

关 键 词：低温 人工 心肺转流术 雄甾烷醇类 神经肌肉阻滞 

分 类 号：R614[医药卫生—麻醉学]