急性等容性血液稀释与自体血回输对哌库溴铵作用时效的影响  

Effect of ANH and autologous transfusion on the onset-duration-recovery profile of pipecuronium

作　　者：牛新环[1,2] 田玉科[3,1] 陈治军[3,1] 张咸伟[3,1] 

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉学教研室,430030 [2]武汉市(现在山东省立医院麻醉科) [3]武汉市,430030

出　　处：《中华麻醉学杂志》2003年第11期809-811,共3页Chinese Journal of Anesthesiology

基　　金：湖北省科技攻关计划重点项目(2001AA307B04)

摘　　要：目的 观察术前急性等容性血液稀释与术中回收式自体血回输对哌库溴铵作用时效的影响。方法 择期神经外科手术病人45例,随机分为三组:A组(n=15)对照组;B组(n=15)术前急性等容性血液稀释(ANH)组;c组(n=15)ANH联合回收式自体血回输组。B组和C组在麻醉诱导前行ANH。C组自手术开始即收集术野血洗涤备回输。A组未行特殊处理。观察各组病人的生命体征,检测ANH前后和自体血回输后血浆蛋白和血红蛋白的变化。用四个成串刺激(TOF)的模式监测哌库溴铵的作用时效。结果 B组和C组血液稀释后血浆蛋白和血红蛋白明显低于A组和术前(P<0.05),自体血回输后B组与A组差异无显著性(P>0.05),C组血红蛋白明显高于其它两组(P<0.05),血浆蛋白与其它两组差异无显著性(P>0.05);与A组相比,B组和C组诱导量哌库溴铵的起效时间、峰作用时间、临床时效和维持量的临床时效均明显缩短(P<0.05),B组和C组各时效间差异无显著性(P>0.05),恢复指数三组间差异无显著性(P>0.05)。结论 ANH使哌库溴铵的起效时间和作用时间明显缩短,对恢复指数无明显影响;术中回收式自体血回输对哌库溴铵的恢复指数亦无明显影响。Objective To investigate the effect of acute normovolemic hemodilution (ANH) and autologous transfusion on the onset-duration-recovery profile of pipecuronium in patients undergoing neurosurgery. Methods Forty-five ASAl-Ⅱ patients aged 18-60 yr undergoing neurosurgery were divided into three groups,group A:control (n=15);group B: ANH (n=15) and guoup C: ANH + intraoperative blood salvage (n=15).The estimated blood loss during operation was less than 12 ml·kg-1 in group A; whereas in group B and C more than 12 ml·kg-1. Their preoperative Hb was > 135 g·L-1 and Hct > 35%.The patients were premedicated with intramuscular phenobarbital 0.1g and atropine 0.5 mg. In group B and C 8-12 ml·kg-1 of blood was withdrawn from cubital vein in 10-15 min and equal volume of 6% hydroxyethyl was infused at the same speed simultaneously before anesthesia. In group C the blood shed during operation was collected and anticoagulated for reinfusion. Anesthesia was induced with fentanyl 4-6μg·kg-1 , propofol 2 mg·kg-1 and pipecuronium 0.1 mg·kg-1.The patients were mechanically ventilated after tracheal intubation and PETCO2 was maintained at 25-35 mm Hg. Anesthesia was maintained with 1%-3% isoflurane and intermittent iv boluses of fentanyl and pipecuronium. Lactated Ringer's solution was infused at 10-12 ml·kg-1.h-1 during operation in all patients. ECG, NIBP, SpO2, PETCO2 and CVP were monitored throughout anesthesia. Plasma protein, Hct and Hb were measured before and after ANH and after reinfusion of the shed blood. Neuromuscular function was assessed using a train-of-four stimulation (TOF). Onset time, peak effect time (when T1 decreased to 0), duration of action (from the end of pipecuronium injection to recovery of T1 to 25% of the control) of intubation dose and maintenance dose and recovery index (recovery of T1 from 25 % - 75%) were recorded.Results Demographic data including sex, age, body weight and height were not significantly different among the three groups. The vital signs were stable in the three groups. Pla

关 键 词：急性等容性血液稀释 自体血回输 哌库溴铵 作用时效 

分 类 号：R96[医药卫生—药理学]