新斯的明拮抗维库溴铵肌松作用的用药剂量和时机探讨

Clinical Study of the Muscular Relax Function of Neostigmine Against Vecuronium Bromide

目的探讨新斯的明拮抗维库溴铵的肌松作用用药剂量和时机。方法将46例患者随机分成A、B、C3组,各组均于术毕前5 min停止连续输注维库溴铵,周围神经刺激不能引起反应时,A组即予静脉推注新斯的明0.035 mg.kg-1+阿托品0.25 mg;B组先予静脉推注新斯的明0.015 mg.kg-1+阿托品0.25 mg,待T1恢复至10%时静脉推注新斯的明0.035 mg.kg-1+阿托品0.25 mg;C组待T1自然恢复至10%时静脉推注新斯的明0.035 mg.kg-1+阿托品0.25 mg。各组记录从停止输注维库溴铵至T1恢复至90%、四个成串刺激(train of four,TOF)恢复至70%和90%的时间以及术毕15 min时T1、TOF的比值。结果B组T1恢复至90%、TOF恢复至70%和90%的时间较A、C组缩短(P<0.01或P<0.05);术毕15 min时T1、TOF比值B组亦较A、C组高(P<0.01)。结论新斯的明拮抗维库溴铵的肌松作用与用药剂量和时机有关。

Objective To explore the muscular relax function of neostigmine against vecuronium bromide. Methods Forty six patients were divided randomly into three groups. Transfusion of vecuronium bromide terminated 5 min before the completion of operation in all the three groups. When peripheral nerves could not react to irritation, 0. 035 mg·kg^-1 of neostigmine and 0.25 mg of atropine were injected intravenously into patients in group A, 0. 015 mg·kg^-1 of neostigmine and 0.25 mg of atropine before 0. 035 mg· kg^-1 neostigmine and 0.25 mg of atropine were injected intravenously as 10 % of T1 recovered in the group B, 0. 035 mg· kg^-1 of neostigmine and 0.25 mg of atropine were injected intravenously as 10 % of T1 recovered naturally in the group C. The time intervals from the terminal of injection intravenously of vecuronium bromide to the 90 % recovery of T1, to 70 % and 90 % recovery of TOF, to T1 of 15 min after the terminal of operation, and the rates of the four series of irrigation （TOF） in all groups were counted. Results T1 was recovered to 90% in group B. The time intervals of TOF recovery to 70 % and 90 % in group B were shortened than that in group A and group C （P〈0.01 or P〈0.05）. The rate of T1 and TOF was higher in group B than that in group A and group C 15 min after the terminal of operation （P〈0.01）. Conclusion The muscular relax function of neostigmine against vecuronium bromide was dose and time depended.