腹部手术患者罗库溴铵不同给药方式肌松效应的比较

Muscle relaxation produced by rocuronium given by different methods of administration in patients undergoing abdominal surgery

目的比较腹部手术患者罗库溴铵靶控输注(TCI)、持续输注(CI)和间断静脉注射(IBI)三种给药方式的肌松效应。方法择期全麻下行腹部手术患者45例,ASAⅠ或Ⅱ级,随机分为TCI组、CI组和IBI组(n=15)。麻醉诱导：三组均静脉注射咪唑安定0．1mg·kg^(-1)、瑞芬太尼1．5μg·kg^(-1)和TCI异丙酚2．5μg·ml^(-1),TCI组以效应室浓度3μg·ml^(-1)TCI罗库澳铵,CI组和IBI组均静脉注射罗库溴铵0．6 mg·kg^(-1)。麻醉维持：三组均维持T_1=5％,TCI组以效应室浓度增减0．1μg·ml^(-1)调控罗库溴铵TCI；CI组以初始速率为600μg·kg^(-1)·h^(-1),每隔5分钟以10％～20％幅度调整输注速率；IBI组间断静脉注射0．15mg·kg^(-1)。结果在肌松监测指导下,TCI组和CI组均可维持T_1=5％的肌松深度,TCI组效应室浓度呈下调趋势,CI组可达到稳态输注,调控次数高于TCI组,IBI组每间隔(27±7)min给药一次,每次间隔时间相似。TCI组罗库溴铵麻醉诱导用量多于CI组和IBI组(P＜0．05),三组维持用量差异无统计学意义。TCI组罗库溴铵诱导起效时间长于CI组和IBI组(P＜0．01)。恢复时间TCI组和CI组相似,短于IBI组(P＜0．01),但三组罗库溴铵的恢复指数差异无统计学意义。结论TCI罗库溴铵延长了起效时间,不适于麻醉诱导；但其肌松效应稳定,停止输注后恢复较快,适于麻醉维持。

Objective To compare the muscle relaxation produced by rocuronium given by targetcontrolled infusion （ TCI ）, continuous infusion （CI） or intermittent, iv. bolus injection （IBI） during abdominal surgery.Methods Forty-five ASA Ⅰ or Ⅱpatients undergoing abdominal surgery under general anesthesia were randomly divided into 3 groups （ n = 15 each） ： group Ⅰ TCI; group ⅡCI and group Ⅲ IBI. Neuromuscular transmission was monitored by recording the force of contraction of adductor pollicis of the left hand to supramaximal TOF stimulation of the ulnar nerve using accelerography （TOF-WATCH SX）. In group 1 rocuronium was given by a TCI system incorporating Stanpump software connected to a Graseby 3500 intravenous infusion pump. The effect site concentration was set at 3 μg· ml^-1 for intubation followed by increament or decreament of 0.1 μg· ml^-1 to maintain T1 at 5 % of the control height while in group Ⅱ the initial infusion rate was set at 600 μg· kg^-1 ·h^-1 followed after intubation by increament or decrcament of 10%-20% of intubating dose every 5 minutes. In group Ⅲ a bolus of 0.6 mg· kg^-1 was given to facilitate intubation followed by intermittent iv boluses of 0.15 mg· kg^-1 . Results During maintenance of anesthesia T, could be maintained at 5 % of the control height in group TCI and CI but not in group IBI. The amount of rocuronium used to facilitate intubation during induction of anesthesia was significantly larger in group TCI than in group CI and IBI （ P 〈 0.05 ）. But there was no significant difference in the amount of rocuronium consumed during maintenance of anesthesia among the 3 groups. The onset time was significantly longer in group TCI than in group CI and IBI. The time for T, to recover from 5 % to 25 % was significantly longer in group IBI than in group TCI and CI, while spontaneous recovery indices were similar among the 3 groups. Conclusions Rocuronium given by TCI is not suitable for induction of anesthesia because of longer onset time but is the method of choice during maintenance of anesthesia because stable muscle relaxation can be achieved with faster recovery after termination.