异氟醚、恩氟醚对罗库溴铵残余肌松作用的影响

Comparison of effects of isoflurane and enflurane on the residual curarization following rocuronium administration

目的观测异氟醚、恩氟醚对罗库溴铵的残余肌构作用的影响。方法选择58例ASAⅠ～Ⅱ级成年择期全麻手术病人,随机分为3组:丙泊酚组(Ⅰ组,21例);异氟醚组(Ⅱ组,20例);恩氟醚组(Ⅲ组,17例)。全麻诱导气管插管后罗库溴铵均以600mg/(kg·h)的速度静脉泵入。Ⅰ组丙泊酚泵入速度为4～10mg/(kg·h),Ⅱ组、Ⅲ组分别吸入呼气末浓度为1MAC的异氟醚或恩氟醚,使用Biometer加速度仪观测T1恢复至25%、75%及TOF比值(T4/T1)恢复至0.7的时间。结果3组间病人的性别、年龄、体重、身高、芬太尼总量、麻醉持续时间和血液动力学变化均差异无显著性(P>0.05)。上述恢复时间,Ⅱ组、Ⅲ组与Ⅰ组比较均延长,差异有显著性(P<0.05);Ⅱ、Ⅲ组比较差别无统计学意义(P>0.05)。3组间恢复指数(T1从25%～75%时间)比较差异无显著性(P>0.05)。结论异氟醚、恩氟醚均可延长罗库溴铵的残余肌松作用。临床应用中应注意监测4个成串刺激(TOF)等,减少术后残余肌松作用所致的并发症。

[Objective] To investigate the effects of 1MAC isoflurane or enflurane on postoperative residual curarization caused by rocuronium （home-made vecuronium）. [Methods] 58 adult patients of ASA grade. Ⅰ - Ⅱ undergoing selective operation under general anesthesia were randomly divided into three groups. Propofol group （group I, n =21）, Isoflurane gropu （group I], n =20） and enflurane group （group lll, n =17）. After general anesthesia induction, all patients were continuously infused with rocuronium at a rate of 600 mg/（kg.h） group I was continuously infused with propofol at rate of 4～10 mg/（kg-h）. Group Ⅱ and Ⅲ inhaled 1MAC isoflurane or enflurane respectively. T1 25% and T175% recovery time were moni-toted by acceleromyograph as well as the 0.7 recovery time of TOF- ratio （T4/T1）. [Results] There were no significant differences among three groups with respect to sex, age, body weight and height, total usage amount of fentanyl, anesthesia duration and their blood dynamics parameters （P 〉 0.05）. Between Ⅱ grorp or group Ⅲ and group Ⅰ, there were significant differences in T1 25% and T1 75% recovery time （P〈0.05）. The recovery time of group lland group Ⅲ was later than that of group Ⅰ. [Conclusion] Both isoflurane and enflurane can increase the residul curarization of rocuronium. Monitoring of TOF should be emphasized during anesthesia in order to decrease the postoperative residual curarization.