地氟烷对米库氯铵临床药效影响的研究  

The influence of Desflurane on pharmacodynamics of mivacurium chloride

作　　者：李亚娟[1] 李庆民[1] 

机构地区：[1]泰山医学院附属泰山医院,山东泰安271000

出　　处：《泰山医学院学报》2016年第1期27-29,共3页Journal of Taishan Medical College

摘　　要：目的观察5.6%地氟烷复合异丙酚和瑞芬太尼麻醉下对米库氯铵临床药效学的影响,为临床合理用药提供依据。方法选择2015年4月-2015年5月在本院行全麻择期手术ASA分级为Ⅰ-Ⅱ级的患者40例。所选患者均未使用影响肌肉松弛作用的药物,患者本人及其亲属均无神经肌肉系统疾病,将患者随机分为两组,每组20例,随机分成地氟烷组（Ⅰ组）,异丙酚组（Ⅱ组）。麻醉前30分钟肌肉注射阿托品0.5mg。未用米库氯铵前,静脉注射咪唑安定0.1 mg/kg、异丙酚1.5-2 mg/kg、芬太尼2-4μg/kg诱导,使用喉罩行机械通气。Ⅰ组用异丙酚2-5 mg/（kg·h）静脉输注,瑞芬太尼4 ng/ml血浆靶控输注,维持呼出末地氟烷浓度为1MAC（浓度：5.6%）;Ⅱ组用异丙酚4-10 mg/（kg·h）静脉输注,瑞芬太尼4 ng/ml血浆靶控输注维持麻醉。未给米库氯铵之前,调节电极使TOF值稳定在100%。待上述指标稳定5分钟后,静脉注入米库氯铵0.15 mg/kg。肌松监测仪调校好后,即开始TCI,观察与TOF相关的指标并记录：（1）起效时间：指米库氯铵注入静脉完毕至达到肌肉最大肌松的时间;（2）作用时间：是指米库氯铵注入静脉完毕至T1恢复到25%的时间;（3）维持T1为1%-10%时米库氯铵的泵入速度;（4）恢复指数：是指从T1恢复至对照25%到T1恢复至对照75%的时间。结果静脉注入米库氯铵0.15 mg/kg后,Ⅰ组和Ⅱ组的起效时间分别是（103.7±20.4）s和（98.4±26.3）s（P〉0.05）,作用时间分别是（29.4±9.1）min和（17.2±8.6）min,维持90%-99%颤搐抑制所需米库氯铵的泵注速度分别为5.95±1.72μg/（kg·min）和8.65±1.90μg/（kg·min）,恢复指数分别为（11.85±3.96）min和（6.52±3.54）min。结论在临床麻醉过程中地氟烷可以显著增强米库氯铵的临床肌松药时效,并且减少维持90%-99%肌松所需的泵入速度。Objective： To investigate the pharmacodynamics effects of 2. 5% Desflurane and propofol and remifentanil under intravenous anesthesia on mivacurium chloride to provide evidence for clinical rational drug use. Methods： Forty ASAⅠ- Ⅱpatients under general anesthesia were randomly divided into two groups of 20 patients each,namely,desflurane group（ GroupⅠ） and propofolum group（ GroupⅡ）. Laryngeal mask was applied for mechanical ventilation without the aid of muscle relaxants. In Group I,patients were given intravenous infusion with 2 - 5 mg /（ kg·h） propofol and 4 μg / ml remifentanil,plasma target-controlled,and the anesthesia was maintained by continuous end exhaling 1MAC desflurane（ density： 5. 6%）. In group II,patients were given intravenous infusion with 4 - 10 mg/（ kg·h） propofol and 4μg/ml remifentanil,plasma target-controlled,and the anesthesia was maintained. After the above mentioned index stabilized for 5minutes,mivacurium chloride（ 0. 15 mg / kg） was intravenously infused. Before the administration of muscle relaxant,electrode was adjusted to maintain the value of TOF at 100%. After completing the adjustment of muscle relaxation monitor,TCI was started to record TOF and the following index was observed：（ 1） Onset time： the time between the completion of the administration of muscle relaxant and approaching of maximum muscle relaxants.（ 2） Action time： the time between the completion of the administration of muscle relaxant and the recovery of T1 to 25%.（ 3） Recovery index： the time between the recovery of T1 to 25% and to 75%.（ 4） The maintenance of T1 is the pumping speed for 1% - 10% muscle relaxants. Results： After mivacurium chloride（ 0. 15 mg / kg） was intravenously infused,the onset time for group Ⅰ and Ⅱ is（ 103. 7 ± 20. 4） s and（ 98. 4 ± 26. 3） s respectively（ P〉 0. 05）; the action time is（ 29. 4 ± 9. 1） min and（ 17. 2 ± 8. 6） min respectively; the pumping speed for mivacurium chloride to mainta

关 键 词：地氟烷 米库氯铵 药理学 

分 类 号：R614.2[医药卫生—麻醉学]