两种麻醉方式对持续输注顺式阿曲库铵肌松效应的影响

Effect of sevoflurane versus propofol-remifentanil anesthesia on neuromuscular blockade by continuous cisatracurium infusion

目的比较七氟烷吸入麻醉与丙泊酚-瑞芬太尼全凭静脉麻醉对持续输注顺式阿曲库铵肌松效应的影响。方法选择全麻下手术病人40例,随机分为七氟烷吸入麻醉组(Ⅰ组)和丙泊酚-瑞芬太尼组(Ⅱ组),各20例。静脉注射顺式阿曲库铵0.15mg/kg后气管插管,术中持续输注顺式阿曲库铵,调节输注速率维持T1≤5%。记录顺式阿曲库铵输注速率、3h时用药量,恢复指数、停药至TOF比值为0.9的时间。结果与初始输注速率比较,两组持续给药30～180min期间顺式阿曲库铵输注速率下降(P<0.05),且Ⅰ组输注速率显著低于Ⅱ组,总体平均输注速率较Ⅱ组减少28%。但120min后两组输注速率无明显变化。两组恢复指数、停药到TOF比值为0.9的时间差异均无统计学意义(P>0.05)。结论持续输注顺式阿曲库铵维持恒定肌松水平,七氟烷麻醉与丙泊酚-瑞芬太尼全凭静脉麻醉均能呈时间依赖性增强其肌松作用,输注120min时达最大程度,且前者的增强效应大于后者,但对肌松恢复的影响无明显差别。

Objective To compare the effects of sevoflurane and propofol-remifentanil anesthesia on neuromuscular blockade produced by continuous cisatracurium infusion. Methods Forty ASA I or II patients undergoing selective surgery were randomly divided into sevoflurane and propofol-remifentanil anesthesia groups （n=20）. Neuromuscular blockade was monitored using train-of-four （TOF） stimulation by recording the contraction force of the adductor pollicis muscle with a muscle relaxation monitor. A bolus dose of cisatracurium of 0.15 mg/kg was administered to facilitate endotracheal intubation, followed by continuous infusion adjusted manually to maintain the first twitch （T1） ≤5% of the control level. The following variables were recorded including the infusion rate, total amount of cisatracurium, spontaneous recovery index （RI）, and the time interval from termination of infusion cisatracurium to recovery of TOF ratio （TOFR） to 0.9. Results With the maintenance of a 95%-99% neuromuscular blockade, the infusion rate was significantly lower in sevoflurane group than in propofol-remifentanil group （P0.05）, and stabilized in both groups after 120 min. No significant differences were found in RI or the time to TOFR of 0.9 between the two groups （P0.05）. Conclusion During the maintenance of stable neuromuscular blockade by continuous cisatracurium infusion, both sevoflurane and propofol-remifentanil anesthesia can time-dependently enhance the effect of cisatracurium without producing significant differences in the recovery properties.