罗库溴铵术后残留作用研究——与维库溴铵和阿曲库铵的比较

Research of postoperative residual curarization of rocuronium-a comparison with vecuronium and atracurium

目的 :研究依据临床指征拔除气管导管后罗库溴铵、维库溴铵和阿曲库铵的肌松残留情况。方法 :6 0例择期手术患者随机分成维库溴铵 (VEC)、罗库溴铵 (ROC)及阿曲库铵 (ATR)三组 ,每组 2 0例。静吸复合麻醉。肌松药首量 :VEC组 12 0 μg/kg ;ROC组 6 0 0 μg/kg ;ATR组 5 0 0 μg/kg。术中用四个成串刺激 (TOF)监测肌松 ,当其值 (TOFR)至 0 .1时追加肌松药 1×ED 95。结果 :维库溴铵末次给药作用时间长于罗库溴铵 (P <0 .0 1)和阿曲库铵 (P <0 .0 5 ) ;拔管时各组TOFR及TOFR <0 .75的例数均无统计学差异 (P >0 .0 5 )。阿曲库铵残留时间短于维库溴铵 (P <0 .0 1)和罗库溴铵 (P <0 .0 5 )。结论 :非去极化肌松药罗库溴铵与维库溴铵和阿曲库铵一样 ,用药后若依据临床指征拔除气管导管都有发生术后肌松残留的危险。

Objective:To test the postoperative residual curarization (PORC) of rocuronium,and compare with vecuronium and atracurium.Methods:60 ASA I-II patients for elective surgery were randomly allocated to ROC,VEC or ATR group respectively.Each group ( n =20) received a mixed anesthesia with propofol,fentainyl,isoflurane and N 2O.The 2×ED 95 of rocuronium (600 μg/kg,ROC group),vecuronium (120 μg/kg,VEC group) or atracurium (500 μg/kg,ATR group) was given during anesthesia induction.During operation, neuromuscular blockade was continuously evaluated with train-of-four stimuli (TOF).When the TOF rate (TOFR) reached 0.1,1×ED 95 muscle relaxant was given.Anesthetists were blind to the muscle relaxants.After operation,the patient recovered spontaneously.Clinical conditions of tracheal extubation included:patient was able to open his/her eyes and to raise his/her arm and head for 5s.Results:Effect duration of last vecuronium (106.4±20.1 min) was longer than that of rocuronium (82.6±8.5 min, P <0.01)and atracurium (85.1±10.9 min, P <0.05).The TOFR of VEC,ROC and ATR groups at the time of tracheal extubation were respectively 0.60±0.17,0.61±0.09 and 0.66±0.11 (compared between every two groups, P > 0.05 ).The patient number of TOFR<0.75 at the time of tracheal extubation were respectively 14,16 and 13 (compared between every two groups, P >0.05).The duration of residual neuromuscular blockade of atracurium (15.0± 9.5 min ) was shorter than vecuronium (24.4±11.0 min, P <0.01)and rocuronium (21.6±14.2 min, P <0.05).Conclusions:There will be a high risk of morbidity in PORC after tracheal extubation under the guidance of clinical judgment only,no matter the kind of non-depolarizing muscle relaxant are used.