异氟醚吸入麻醉与异丙酚静脉麻醉下长时间持续输注罗库溴铵的肌松作用

The neuromuscular blockade produced by prolonged infusion of rocuronium during isoflurane versus propofol anesthesia

目的比较异氟醚吸入麻醉与异丙酚静脉麻醉下长时间持续输注罗库溴铵的肌松作用。方法拟在全麻下行口腔-颌面肿瘤择期手术(手术时间达5 h左右)病人30例,ASAⅠ或Ⅱ级,年龄18～65岁,随机分为2组(n=15):异丙酚组(Ⅰ组)异氟醚组(Ⅱ组)。用TOF-Watch SX肌松监测仪进行拇内收肌肌松监测。静脉注射罗库溴铵初始剂量0．6 mg·kg-1后气管插管,持续输注罗库溴铵。调整罗库溴铵的输注速率,T1稳定在基础值的10％时(初始状态),Ⅰ组靶控输注异丙酚维持麻醉,Ⅱ组吸入1 MAC异氟醚维持麻醉,持续5 h,术中维持T1在基础值的10％。记录罗库溴铵输注速率、恢复指数(T1恢复25％至75％的时间,T25-75)以及罗库溴铵停止输注到TOFR为0．9的时间。结果与初始状态比较,Ⅰ、Ⅱ组持续给药30 min-5 h时罗库溴铵输注速率下降(P<0．05);Ⅱ组持续给药1～5 h时罗库溴铵输注速率低于Ⅰ组(P<0．05)。两组间恢复指数和罗库溴铵停止输注到TOFR为0．9的时间差异无统计学意义(P>0．05)。结论罗库溴铵可用于长时间持续输注以维持稳定的肌松。维持T1在基础值的10％的情况下,持续输注罗库溴铵5 h时异氟醚麻醉比异丙酚为主的全凭静脉麻醉罗库溴铵输注速率减少30％,但其恢复指数无差异。

Objective To compare the neuromuscular blockade produced by rocuronium after prolonged infusion during isoflurane or propofol anesthesia. Methods Thirty ASA Ⅰ or Ⅱ patients aged 18-65 yrs undergoing prolonged elective surgery for oral-maxillofacial carcinoma lasting for about 5h were allocated to 2 groups of 15 patients each： group Ⅰ propofol anesthesia （P） and group Ⅱ isoflurane anesthesia （ISO） . Neuromuscular block （N-M block） was monitored using train-of-four （TOF） stimulation by recording the force of contraction of adductor policis muscle with a muscle relaxation monitor （TOF Watch Sx） . Rocuronium 0.6 mg·kg^-1 was administered as a bolus to facilitate endotracheal intubation, followed by continuous Ⅳ infusion adjusted manually to maintain T1 , the first twitch in the TOF, at 10% of control . The following variables were recorded： the infusion rate, spontaneous recovery index （T25-75） and the time interval from T1 at 10% of control to recovery of TOF ratio to 0.9. Results During the 5th hour the infusion rate was （8.2 ± 0.6）μg·kg^-1·min^-1 in group 1 （propofol） and （5.5 ± 0.7）μg·kg^-1·min^-1 in group Ⅱ （isoflurane） respectively （ P 〈 0.05）, There was no significant difference in the spontaneous recovery index between the two groups, Conclusion Rocuronium can be administered as continuous infusion to maintain stable N-M block. During the 5th hour the infusion rate of rocuronium to maintain T1 at 10% of control is reduced by 30% during isoflurane anesthesia as compared with propofol anesthesia. There is no significant difference in the spontaneous recovery index between the two groups.