小剂量阿曲可林与筒箭毒联合分次静脉注射的临床观察

CLINICAL OBSERVATION OF NEUROMUSCULAR BLOCKADE BY COMBINATIONS OF ATRACURIUM AND D-TUBOCURARINE WITH LESS DOSAGE

34例ASAⅠ—Ⅲ级外科病人,随机分三组,阿曲可林组:首次剂量0.6mg/kg,维持剂量0.1m/kg筒箭毒组:首次剂量0.6mg/kg,维持剂量0.15mg/kg;阿曲可林与筒箭毒组:首次剂量为各单独用量的1/2,维持剂量为各单独用量的1/3。结果:联合用药首次剂量的起效时间(4.03min)快于筒箭毒组(8.8min),维持时间(55.28min)比单独用药长;分次静注的维持时间(46.75min)比筒箭毒(59.94min)短,明显长于阿曲可林组(18.19min),停药后联合用药的恢复时间(26.95min)与阿曲可林组(25.33min)相仿,明显短于筒箭毒组(87.42min)。联合用药首次剂量后心率增快,平均动脉压平稳,术中心率及平均动脉压平稳,与阿曲可林组相同,筒箭毒组首次剂量后平均动脉压降低,心率略增,术中平均动脉压低于术前。结论:临床应用小剂量阿曲可林和筒箭毒大大减轻了筒箭毒起效慢、恢复时间长、蓄积作用明显及神经节阻滞和组织胺释放的不良反应,同时也延长阿曲可林间断用药的维持时间。

Administration of atracurium (ATC), d-tubocurarine(dTc) or combinations of ATC and dTc were given to A.S.A. class Ⅰ—Ⅲ surgcal patients during intravenous procainefentanyl balanced anesthesia to determine neuromuscular effects. The time of onset to blackade T_1<25% after administration of the initial dose of ATC and dTc combinations (4.03min) was sifnificantly more rapid than dTc alone (8.33min), the time of action with the initial dose of combinations (55.28min) was persistently longer than either dTc or ATC alone. The time between the divideb dose with combinations (46.75min) was significantly shorter than it with dTc (59.94min), and longer than it with ATC (18.19min). The recovery time of T_1 from 25% to 75% with combinatons (26.95min) was as similar as it with ATC (25.33min), but significantly shorter than it with dTc (87.42min). HR was increased after administration of the combinations or ATC, and MAP decreased significantly after administration of dTc. It was concluded that combined use of dTc-ATC with less dosage not only reduced the disadvantages and side effects of dTc such as showed in onset and recovery, autonomic gangtionic blockade and histamine release, but also prolonged and potentiated the neuromuscular blockade of ATC.