不同剂量顺式阿曲库铵对患者拇内收肌与眼轮匝肌肌松效应的比较

Comparison of neuromuscular blocking effects of different doses of cisatracuroulum on orbicularis oculi and adductor pollicis muscle

目的比较不同剂量顺式阿曲库铵对患者拇内收肌与眼轮匝肌的肌松效应。方法全麻患者25例，ASAI或Ⅱ级，年龄42～64岁，体重51～81kg，随机分为2组，顺式阿曲库铵0．075mg／kg组（Ⅰ组，n=11）和顺式阿曲库铵0．15mg／kg组（Ⅱ组，n=a4）。静脉注射咪达唑仑0．035～0．045mg／kg、异丙酚1．5～2mg／kg、芬太尼0．1～0．2mg、顺式阿曲库铵0．075mg／kg或0，15mg／kg行麻醉诱导，吸入50％氧化亚氮、间断静脉注射芬太尼维持麻醉。采用2台TOF—Watch SX加速度肌松监测仪同步监测眼轮匝肌和拇内收肌的神经肌肉阻滞情况，记录肌松起效时间、无反应期及T25％和T75％恢复时间。于眼轮匝肌肌颤搐抑制75％～80％时行气管插管，并评价气管插管条件。结果2组气管插管条件良好且差异无统计学意义（P〉0．05）；与Ⅰ组比较，Ⅱ组拇内收肌和眼轮匝肌肌松起效时间缩短，T25％恢复时间、T75％恢复时间和无反应期延长（P〈0．01）；与拇内收肌比较，Ⅰ组眼轮匝肌T75％恢复时间缩短，Ⅱ组眼轮匝肌无反应期和T25％恢复时间缩短（P〈0。05或0．01）。结论顺式阿曲库铵对拇内收肌和眼轮匝肌的肌松效应呈剂量依赖性，眼轮匝肌对顺式阿曲库铵的敏感性低于拇内收肌；监测顺式阿曲库铵对眼轮匝肌神经肌肉阻滞情况可有效指导气管插管。

Objective To compare the neuromuscular blocking effects of different doses of cisatracuronium on orbicularis oculi and adductor pollicis muscle. Methods Twenty-five ASA Ⅰ or Ⅱ patients aged 42-64 yr weighing 51-81 kg undergoing elective operation under general anesthesia were randomly divided into 2 groups： group Ⅰ cisatracuronium 0.075 mg/kg （n = 11）, group n cisatracuronium 0.15 mg/kg （n = 14）. Anesthesia was induced with iv midazolam 0.035-0.045 mg/kg, propofol 1.5-2 mg/kg, fentanyl 0.1-0.2 mg and cisatracuronium 0.075 mg/kg or 0.15 mg/kg and maintained with inhalation of 50% N2O and intermittent iv fentanyl. The neuromuscular blockade of orbicularis oculi and adductor pollicis muscle was determined simultaneously by acceleromyography. The onset time （time from injection of cisatracuronium to maximal paralysis of twitch）, period of no-twitch response and the 25% and 75 % recovery time of the control height of twitch （T25% , T75% ） were recorded. Tracheal intubation was performed when the twitch of orbicularis oculi muscle was depressed by 75 %-80 % and then evaluated. Results The intubation conditions were good without significant difference between both groups（ P 〉 0.05）. The onset time of orbicularis ocufi and adductor pollicis muscle was significantly shorter and T25 % , T75 % and period of no-twitch response longer in group Ⅱ than in group Ⅰ （ P 〈 0.01）. The T25% and T75% of orbicularis oculi muscle in group Ⅰ and the period of no-twitch response and T25% of orbicularis oculi muscle in group Ⅱ were shorter than those of adductor pollicis muscle （P 〈 0.05 or 0.01 ）. Conclusion Cisatracuronium can induce neuromuscular blockade at orbicularis oculi and adductor pollicis muscle in a dose-dependent manner and the sensitivity of orbicularis oculi muscle to cisatracuronium is lower than that of adductor polficis muscle. The monitoring of cisatracuronium-induced neuromuscular blockade at orbicularis oculi muscle can effectively guide tracheal intubation.