预注维库溴铵联合稀释依托咪酯减轻依托咪酯全麻诱导中肌阵挛的临床研究

Efficacy of Pretreatment of Vecuronium Combined with Dilution of Etomidate on Etomidate-induced Myoclonus

目的：旨在评价预注维库溴铵联合稀释依托咪酯减轻依托咪酯全麻诱导中肌阵挛的效果。方法：本研究为前瞻性、双盲、随机对照研究。80名ASA I-II级、年龄1860岁、拟行胆囊切除术的全麻患者被随机分为4组：组1,预注维库溴铵0.01 mg/kg;组2,依托咪酯用生理盐水由2 mg/mL稀释为1 mg/mL;组3,预注维库溴铵联合稀释依托咪酯;组4,生理盐水对照组＋非稀释依托咪酯组。根据分组给予患者预注维库溴铵0.01 mg/kg或同等量的生理盐水,观察并询问患者有无呼吸困难,并记录呼吸频率和脉搏氧饱和度（SpO2）。3分钟后推注稀释或无稀释依托咪酯0.3 mg/kg,询问患者有无注射痛并做疼痛评分,观察有无肌阵挛并评估其程度。2分钟后给予维库溴铵0.1 mg/kg、芬太尼3μg/kg和丙泊酚1 mg/kg行气管插管。实验期间同时记录无创动脉血压（BP）和心率（HR）。结果：组1和组4分别有2例（10%）和3例（15%）患者述轻度注射疼痛,而组2和组3无患者述注射疼痛。组1、组2和组3肌阵挛的发生率明显低于组4（30%、40%和15%vs 70%,P〈0.05）。且组1、组2和组3肌阵挛的程度多为轻中度,而组4多为中重度。四组患者均未述任何呼吸困难,呼吸频率无明显降低,SpO2无明显变化。四组患者BP和HR变化一致,无明显差别。结论：预注小剂量维库溴铵或稀释依托咪酯可明显降低依托咪酯引起肌阵挛的发生率并减轻其程度。且这两种方法联合应用比单独应用效果更佳,具有一定程度的协同作用。

Objective：The aims of this study were to evaluate the influence of pretreatment with vecuronium combined with dilution of etomidate on the incidence of etomidate-induced myoclonus and investigate whether a combination of vecuronium and dilution of etomidate produced additional efficacy compared with either treatment alone.Methods：A prospective double-blind study was performed on 80 ASA physical status I-II patients who were randomized into 4 groups：vecuronium 0.01 mg/kg（Group 1）,dilution of etomidate 2 mg/mL with normal saline to 1 mg/mL（Group 2）,combination of vecuronium and dilution of etomidate（Group 3）,or normal saline（Group 4）.Three minutes after administration of the study solution,anesthesia was induced with etomidate 0.3 mg/kg.Two minute later,each patient was administered vecuronium 0.1 mg/kg,and a propofol 1 mg/kg and fentanyl 3 μg/kg were administered to facilitate tracheal intubation.The patients were observed for any myoclonic movement.Grade of infusion pain,incidence of myoclonus,breathing frequency,and pulse oxygen saturation were measured during the study period.Results：The frequency of pain on injection of etomidate was 10% in Group 1 and 15% in Group 4,with all pain graded as mild.The frequency and severity of patients experiencing myoclonus were significantly reduced in Groups 1,2 and 3 compared with Group 4（30%,40% and 15% vs 70%,P〈0.05）.No patient expressed any symptoms or signs of hypoxia and respiratory difficulty among four groups.Conclusion：Pretreatment with a small dose of vecuronium combined with dilution of etomidate significantly reduced the frequency and severity of etomidate-induced myoclonus,and was more effective than either treatment alone.