顺阿曲库铵用于麻醉诱导气管插管的肌松效应与重症肌无力分型的关系  

Relationship between neuromuscular block induced by cisatracurium for tracheal intubation during anesthesia induction and types of myasthenia gravis

作　　者：贾瑞芳[1] 孟小燕[1] 周淑珍[1] 左明章[1] 

机构地区：[1]北京医院国家老年医学中心麻醉科,100730

出　　处：《中华麻醉学杂志》2017年第4期454-457,共4页Chinese Journal of Anesthesiology

摘　　要：目的确定顺阿曲库铵用于麻醉诱导气管插管的肌松效应与重症肌无力分型的关系。方法择期行胸腔镜下胸腺切除术的重症肌无力患者65例，性别不限，年龄20～75岁，体重53～92 kg，身高155～185 cm，ASA分级Ⅰ或Ⅱ级，其中单纯眼肌型（Ⅰ型）8例，轻度全身型（Ⅱa型）19例，重度全身型（Ⅱb型）33例，急性进展型（Ⅲ型）2例，迟发重症型（Ⅴ型）3例。患者麻醉诱导意识消失后启动肌松监测，采用滴定法静脉注射顺阿曲库铵，首次静脉注射的剂量为0.05 mg/kg，若6 min内T1抑制〈95%，则再次静脉注射顺阿曲库铵0.015 mg/kg，直至T1抑制〉95%后行气管插管。记录顺阿曲库铵气管插管用量、肌松起效时间（从给药开始到T1抑制〉95%的时间）和恢复时间（T4/T1恢复到25%的时间）。给予1倍ED95顺阿曲库铵后6 min内T1抑制〉95%认为对肌松药敏感，T1抑制〉95%时需要〉1倍ED95顺阿曲库铵认为对肌松药不敏感，计算肌松药敏感/不敏感比例。结果Ⅰ型和Ⅱa型重症肌无力患者顺阿曲库铵气管插管用量、肌松起效时间和恢复时间比较差异无统计学意义（P〉0.05）；与Ⅰ型和Ⅱa型比较，Ⅱb型重症肌无力患者顺阿曲库铵气管插管用量降低，肌松药敏感/不敏感比例升高，肌松起效时间缩短，恢复时间延长（P〈0.05）。结论随分型的加重，顺阿曲库铵用于重症肌无力患者麻醉诱导气管插管的用量降低，敏感性增加。Objective To determine the relationship between neuromuscular block induced by cisatracurium for tracheal intubation during anesthesia induction and types of myasthenia gravis（MG）.Methods Sixty-five patients of both sexes with MG, aged 20-75 yr, weighing 53-92 kg, with body height of 155-185 cm, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing elective video-assisted thoracoscopic thymectomy, were enrolled in the study.Among the 65 patients, there were 8 patients with ocular MG（typeⅠ）, 19 patients with mild generalized MG（typeⅡa）, 33 patients with subacute generalized MG（typeⅡb）, 2 patients with acute MG（type Ⅲ） and 3 patients with late severe MG（type Ⅳ）. Neuromuscular monitoring was initiated when the patients lost consciousness after induction of anesthesia.Cisatracurium was administrated with the initial dose of 0.05 mg/kg, and if T1 depression was less than 95% within 6 min, cisatracurium 0.015 mg/kg was intravenously injected until T1 depression was more than 95%.The patients were then tracheally intubated.The amount of cisatracurium consumed for intubation, onset time（from the beginning of cisatracurium injection to T1 depression 〉95%） and recovery time（recovery of T4/T1 to 25% of control height） of neuromuscular block were recorded.T1 depression 〉 95% within 6 min after administration of 1-fold ED95 cistracurium was defined as sensitivity to muscle relaxants.The requirement for cistracurium 〉 1-fold ED95 when T1 depression 〉 95% was defined as insensitivity to muscle relaxants.The proportion of sensitivity/insensitivity was calculated.Results There was no significant difference in the amount of cisatracurium consumed for intubation and onset time and recovery time of neuromuscular block between patients with typeⅠ and those with typeⅡa（P〉0.05）. Compared with patients with typeⅠ and type Ⅱa, the amount of cisatracurium consumed for intubation was significantly decreased, the proportion of sensitivity/insensitivity

关 键 词：雄甾烷醇类 重症肌无力 插管法 气管内 剂量效应关系 药物 

分 类 号：R614[医药卫生—麻醉学]