硫酸镁对新斯的明拮抗阿曲库铵肌松效应的影响

Effect of Neostigmine on Atracurium-induced Neuromuscular Blockage in Patients Pretreated with Magnesium Sulphate

目的研究硫酸镁对新斯的明拮抗阿曲库铵肌松效应的影响。方法将40例接受择期妇科腹腔镜手术的按照美国麻醉医师协会(ASA)体格情况分级为Ⅰ级患者随机分为A、B、C、D4组,每组10人。具体为:A、C组患者在麻醉诱导前静脉输注30mg/kg硫酸镁并进行配对,而B、D组则输注相等容量的生理盐水并进行配对。用芬太尼和异丙酚进行麻醉诱导,并采用四次成串刺激方式进行肌松监测。借助阿曲库铵0.50mg/kg进行插管,当四次成串刺激中第1个反应与对照反应的比值(T1/TC)恢复至10%时,给予C和D组患者新斯的明(0.02mg/kg)和阿托品(0.01mg/kg)合剂;而A和B组患者则给予等容量的生理盐水。在予以肌松拮抗剂或生理盐水后10min内每隔1分钟记录肌松恢复情况(T1/TC值)。观察输注硫酸镁或生理盐水及新斯的明和阿托品合剂时血流动力学变化情况,同时记录患者的不适情况。结果A、B两组肌松恢复至10%后的恢复速度差异无显著性(P>0.05);C组肌松恢复至10%后的肌松恢复速度低于D组(P<0.05)。AC组肌松恢复效应的差值小于BD组(P<0.05)。在给予硫酸镁及新斯的明和阿托品合剂后,所有患者血流动力学稳定,并未出现心率、血压明显波动。结论麻醉诱导前预注射硫酸镁可以降低新斯的明对阿曲库铵肌松的拮抗效应。

Objective To determine the effect of neostigmine on antagonizing atracurium-induced neuromuscular blockage with sulfate magnesium pretreatment. Methods Forty patients who undertook elective gynecologic laparoscopic examinations and treatments under general anesthesia were randomized into four groups(group A, B, C, and D, group A paired with group C, and group B paired with group D). Before induction of general anesthesia, patients in group A and group C received MgSO4 30 mg/kg in saline intravenously within 5 min, while patients in group B and group D received the same volume of saline. Anesthesia was induced with fentanyl and propofol; subsequently tracheal intuba-tion was performed with 0.5 mg/kg atracurium after stabilization of the electromyography recording, and neostigmine(0.02 mg/kg)and atropine(0.01 mg/kg)were infused in group C and group D when neuromuscular recovery(T1/TC)reached 10%. T1/TC changes after neostigmine infusion as well as haemodynamic changes and other responses during induction and neostigmine and atropine infusion were recorded. Results The neuromuscular recovery speed had no significant difference between group A and group B after the neuromuscular recovery reached 10%, but it was lower in group C than in group D(P < 0.05). Significant difference existed between group AC and group BD(P < 0.05). No haemodynamic changes and other responses were found during induction and neostigmine and atropine infusion. Conclusion Neostigmine-induced neuromuscular recovery can be attenuated in patients pretrea-ted with magnesium sulfate.