瑞芬太尼对全麻患者罗库溴铵肌松作用的影响

Effect of remifentanil on rocuronium-induced neuromuscular block during general anesthesia

目的评价瑞芬太尼对全麻患者罗库溴铵肌松作用起效、维持和恢复时间的影响。方法45例择期手术患者,年龄20～65岁,ASAⅠ或Ⅱ级。随机分为3组(n=15):单纯异丙酚组(P组)、异丙酚复合瑞芬太尼组(R组)和单纯异氟醚组(Ⅰ组),观察并记录静脉注射插管剂量(2×ED95)的罗库溴铵后各组患者肌松起效、维持和恢复时间以及自主呼吸恢复的情况。结果三组肌松起效时间比较差异无统计学意义(P>0．05);Ⅰ组肌松维持时间、75％恢复时间和恢复指数均长于P组和R组(P<0．05),R组与P组比较差异无统计学意义(P>0．05)。R组患者术中无一例恢复自主呼吸,与Ⅰ组和P组比较差异有统计学意义(P<0．01)。结论术中靶控输注瑞芬太尼对罗库溴铵的肌松作用无影响。

Objective To investigate the effect of remifentanil （R） given by target-controlled infusion （TCI） on the rocuronium-induced neuromuscular （N-M） block during general anesthesia with propofol or isoflurane. Methods Forty-five ASA Ⅰ or Ⅱ patients aged 20-65 yrs undergoing elective abdominal surgery under general anesthesia were randomly divided into 3 groups （ n = 15 each） ： group Ⅰ propofol （P） ; group Ⅱ propofol ＋ remifentanil （R） and group Ⅲ isoflurane （Ⅰ）. The patients were premedicated with inlramuscular pethidine 50 mg, promethazine 25 mg and scopolamine 0.3 rag. Epidural catheter was placed at T9/10.10/11 or 11/12 interspace before induction of anesthesia and correct placement was confirmed by a test dose of 2% lidocaine 3 ml. In group Ⅰ anesthesia was induced and maintained with TCI of propofol （ target plasma concentration at 4 mg·L^-1） while in group Ⅱ with TCI of propofol （target plasma concentration at 4 mg·L^-1 ） and remifentanil （target plasma concentration at 4 μg·L^-1）. Rocuronium 0.6μg·kg^-1 was given i.v. to facilitate tracheal intubation. In group m anesthesia was induced with TCI of propofol as in group Ⅰ and maintained with 0.9% isoflumne. Tracheal intubation was facilitated with succinylcholine 100 mg. Rocuronium 0.6 mg·kg^-1 was given at 5 min after T1 returned to 100% of control level before succinylcholine. N-M function was monitored and recorded using acceleromyography （TOF-GUARD, Organon Teknika N. V. ）. The force of thumb adduction in response to single and TOF stimulation of ulnar nerve was recorded. The recovery of spontaneous breathing was also recorded. Results The onset time of N-M block was comparable among the 3 groups ranging from 56 to 58 seconds. The duration of N-M block, the 75% recovery time and the recovery indexes in isoflurane group were significantly longer than those in group P and R （P 〈 0.05）. There was no significant difference in the above parameters between group P and R. No patient breathed spontaneously in group R during operation while 9 patients in group P and 5 patients in group Ⅰ showed signs of spontaneous breathing. Conclusion TCI of remifentanil has no effect on rocuroniuminduced N-M block.