预注地佐辛对抑制依托咪酯乳剂诱发肌阵挛和插管应激反应的影响  

Dezocine inhibits etomidate emulsion-induced myoclonus and induction reaction

作　　者：王建珍[1] 李国燕[1] 刘冬梅 

机构地区：[1]上海市第二人民医院麻醉科,上海200011

出　　处：《广东医学》2018年第1期31-33,36,共4页Guangdong Medical Journal

摘　　要：目的比较全麻期间地佐辛与咪达唑仑抑制依托咪酯乳剂诱发肌阵挛的效果和插管应激反应。方法择期全身麻醉手术的患者42例,ASAⅠ~Ⅱ级,年龄14~72岁,体重44~80 kg。随机分为地佐辛组和咪达唑仑组,每组各21例。采用盲法,行麻醉诱导的人员不知晓预注药名称,并由其观察肌阵挛及不良反应。地佐辛组和咪达唑仑组分别静脉注射地佐辛0.1 mg/kg和咪达唑仑2 mg,5 s注完,观察头晕发生情况。预注药1.5 min后静脉注射依托咪酯0.3 mg/kg,20~30 s注完,观察肌阵挛发生情况。注射依托咪酯1.5 min后顺序静脉注射舒芬太尼0.3~0.4μg/kg、罗库溴铵0.6~0.9 mg/kg,待下颌肌肉松弛用可视喉镜行气管插管。记录T0、T1和T2时间点收缩压(SBP)和舒张压(DBP)及心率(HR),观察插管前后心血管等不良反应。结果与T0时间点比较,T1时间点地佐辛组SBP、DBP、HR,咪达唑仑组SBP、DBP显著下降(P<0.01),T2时间点地佐辛组与咪达唑仑组DBP、HR显著增加(P<0.05,P<0.01);与咪达唑仑组比较,地佐辛组T1时间点HR、T2时间点SBP显著下降(P<0.05)。地佐辛组无一例发生肌阵挛,咪达唑仑组有6例(28.6%)出现程度不等肌阵挛,其中轻度3例(14.3%)、中度1例(4.8%)、重度2例(9.5%),肌阵挛发生率地佐辛组显著低于咪达唑仑组(P<0.01);气管插管后流泪发生率地佐辛组(2例,9.5%)显著低于咪达唑仑组(9例,42.9%),差异有统计学意义(P<0.05)。结论预注地佐辛(0.1 mg/kg)比咪达唑仑(2 mg)更能有效抑制依托咪酯乳剂诱发的肌阵挛,且能加深麻醉作用,减轻气管插管应激反应。Objective To compared the efficacies of dezocine and midazolam on stability and inhibition of etomi- date emulsion - induced myoclonus and adverse reaction. Methods Forty - two patients with surgery under general anes- thesia, graded ASA I - II, aged 14 - 72 and weighted 44 - 80 kg were included. Using the random number table method, they were randomly divided into observation group （dezoncine） and the control group （imidazole）. The blind method was applied in this study, as both anesthesia induction staff and observers for the myoelonus and adverse reaction were blin- ded. Intravenous administration of dezoncine （O. 1 mg/kg） and imidazole diazepam （2 mg） were given in observation group and control group, respectively. The dizziness within the 5 seconds after injection were recorded. The etomidate was given within 20 -30 s, and subsequent myoclonus was recorded. Ninety seconds after the injection of etomidate, sufen- tanil （0. 3 - 0.4 μg/kg） and rocuronium （0. 6 - 0.9 mg/kg） were given. Visual laryngoscope endotracheal intubation was performed. BP and HR were recorded at TO, T1 and T2. The adverse reactions before and after intubation were also recorded. Results Compared with those at TO, the SBP, DBP and HR at T1 in observation group were significantly de- clined （P 〈 0. 01 ）, and the DBP and HR in both observation group and control group were significantly increased at T2 （P 〈0. 05, P 〈0. 01 ）. Compared with control group, the HR and SBP in observation group at T2 and T1 was significant- ly reduced （ P 〈 0. 05 ）. No myoclonus was reported in observation group, while there was 6 cases of myoclonus were ob- served in control group, including 3 cases with mild myoclonus, 1 case with moderate myoclonus and 2 cases with severe myoclonus. The myoclonus rate was significantly higher in control group （ P 〈 0. 01 ）, so was the incidence of tears after endotracheal intubation （P 〈 0. 05 ）. Conclusion Dezocine is more effective in inhibiting etomidate emulsion - ind

关 键 词：地佐辛 依托咪酯 肌阵挛 

分 类 号：R614[医药卫生—麻醉学]