体温对长时间输注罗库溴铵肌松时效的影响

The Influence of Body Temperature on Prolonged Rocuronium Infusion Requirement in Patients Receiving Intravenous Anaesthesia

目的观察长时间全凭静脉麻醉下病人体温对连续输注罗库溴铵肌松作用的影响。方法选择30例ASAⅠ～Ⅱ级、年龄18-65岁、拟在全麻下行口腔-颌面肿瘤外科择期手术（手术时间5h左右）的病人，随机分为保温组和未保温组，每组15例。行拇内收肌连续肌松监测，应用静脉麻醉药诱导及维持。在麻醉诱导时静脉注射罗库溴铵0．6mg／kg，随后连续输注罗库溴铵并调节输注速率使第一个颤搐反应高度（T1）维持在10％。持续5h观察并记录2组病人的中心体温与罗库溴铵输注速率的变化、罗库溴铵的恢复指数（T1从25％恢复至75％的时间）以及T1从10％至4个成串刺激（TOF）比值为90％的时间。结果与保温组比较，90min后未保温组病人的中心体温、罗库溴铵的输注速率明显下降，术后罗库溴铵的恢复时间明显延长。结论低体温可增强罗库溴铵的肌松作用，延长其在体内的消除时间。

Objective To investigate the influence of body temperature on prolonged rocuronium infusion requirement lasting more than five hours intravenous anasthesis in young adult patients. Methods Thirty ASA Ⅰ -Ⅱ adults undergoing selective oral-maxillofacial surgery were randomly divided into 2 groups： group Ⅰ in which patients＇ body temperature was maintained at 37 ℃ using warming blanket;group Ⅱ in which no measures were taken to maintain the patients＇ body temperature. Intravenous anesthesia was used for both induction and maintenance of anesthesia. Muscle relaxation was monitored by contractibility of musculus adductor pollicis continually. Rocuronium was administered in an initial bolus dose of 0.6 mg/kg followed by an infusion adjusted to maintain the muscle tremulous response（T1 ） at 10% of control. The central body temperature, rocuronium infusive velocity, recovery index of rocuronium relaxation（T1 recovary time from 25% reached 75%） and the time interval from T1 at 10% of control to recovery of the（TOF） ratio to 90% were recorded. Following cessation of rocuronium infusion all the patients were allowed to recover spontaneously. Results Core temperature and rocuroniuminfusion requirement were markedly lowered at 90 min after induction in group Ⅰ as compared with group Ⅱ （P〈 0. 05）. The recovery time for T1 from 25 % return to 75 % and T1 from 10 % return to TOF 90 % in group Ⅰ were longer than in group Ⅱ （P〈0.05）. Conclusion Mild hypothermia can enhance the neuromuscular blockade effect of rocuronium.