预先静注布托啡诺与地佐辛抑制依托咪酯所致肌阵挛效应的比较  

Comparison of the effects of intravenous pre-treatment of Butorphanol and Dezocine on prevention of Etomidate-induced myoclonus

作　　者：张婧[1] 刘玲[1] 吕国义[1] 

机构地区：[1]天津医科大学第二医院麻醉科,300211

出　　处：《天津医药》2015年第12期1450-1453,共4页Tianjin Medical Journal

摘　　要：目的比较布托啡诺与地佐辛对依托咪酯所致肌阵挛的抑制作用。方法拟在全身麻醉下行择期手术的患者150例,ASA分级Ⅰ或Ⅱ级,年龄40~65岁,体质指数(BMI)20~25 kg/m^2,将患者随机分为A、B、C 3组(n=50),A组预先静脉滴注布托啡诺15μg/kg,B组给予地佐辛0.1 mg/kg,C组给予等量生理盐水,给药时间均为30 s,2min后各组均静脉注射依托咪酯0.3 mg/kg(1 min注射完毕),即刻开始观察并记录每组肌阵挛发生的次数及强度,时间均为2 min。同时记录麻醉诱导前(T_0)、给予实验药物后2 min(T_1)、静脉注射依托咪酯后2 min(T_2)各时点每组患者的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO_2)和脑电双频谱指数(BIS)值。并于T_0及气管插管后5 min(T_3)测定血钾浓度。结果 3组发生肌阵挛的阳性率分别为12%、22%、74%。A、B 2组肌阵挛阳性率及强度较C组明显降低,差异有统计学意义(P<0.05);A、B两组比较差异无统计学意义(P>0.05);T_3与T_0时比较,无肌阵挛(O级)及发生1级与2级肌阵挛的患者血钾浓度无明显变化(P>0.05);发生严重肌阵挛的患者(3级)血钾浓度明显升高(P<0.05);T_0、T_1与T_2时刻3组患者的MAP、HR、SpO_2及BIS值差异无统计学意义(P>0.05)。结论预先静脉注射布托啡诺15μg/kg或地佐辛0.1 mg/kg 2 min后均能有效抑制静脉注射依托咪酯引起的肌阵挛,且二者对循环和呼吸系统的影响无明显差异。Objective To compare the inhibitory effects of Butorphanol and Dezocine on Etomidate-induced myoclo？nus. Methods A total of 150 patients with ASA physical statusⅠorⅡ, aged 40-65 yr, with body mass index （BMI） of 20-25 kg/m2, scheduled for elective operations under general anesthesia, were included in this study. Patients were randomly al？located into three groups （A, B and C） with 50 patients in each group. Group A was given intravenous Butorphanol 15 μg/kg for 30 s, group B was given Dezocine 0.1 mg/kg and group C was given equal volume of saline. After 2 min, etomidate 0.3 mg/kg was administrated to three groups. The occurrence and severity of myoclonus were recorded for 2 min after administration of Etomidate. The mean arterial pressure （MAP）, heart rate （HR）, pulse oxygen saturation （SpO2） and Bispectral index （BIS） were recorded at the time points before induction （T0）, 2 min after the experimental drug treatment （T1）, and 2 min after Etomi？date treatment （T2）. At the same time, the concentration of serum potassium was determined at T0 and 5 min after endotrache？al intubation （T3） respectively. Results The positive incidences of myoclonus were 12%in group A, 22%in group B and 74%in group C, respectively. Compared with group C, the positive incidence rates of myoclonus and myoclonus scales were significantly lower in group A and group B （P〈0.05）, but no significant difference between group A and group B （P〉0.05）. Compared with T0, there was no significant difference in the potassium concentration between patients without myoclonus （grade 0） and patients with myoclonus （grade 1 and grade 2） at T3 （P〉0.05）. There was a significant increase in potassium concentration in patients with grade 3 （P〈0.05）. There were no significant differences in MAP, HR, SpO2 and BIS values at T0, T1 and T2 between three groups of patients （P〉0.05）. Conclusion Pre-treatment of Butorphanol （15μg/kg） or Dezocine （0.1 mg/kg） can reduce t

关 键 词：布托啡诺 依托咪酯 肌阵挛 受体 阿片样 κ 地佐辛 

分 类 号：R614[医药卫生—麻醉学]