静脉预注利多卡因对罗库溴铵肌松起效时间的影响

目的探讨静脉预注利多卡因对罗库溴铵肌松起效时间的影响。方法ASAⅠ～Ⅱ级、在气管插管全身麻醉下行择期手术的男性患者60例,年龄18～49岁,体重41～82kg,随机分为利多卡因组(Li组)与对照组(C组),每组各30例。麻醉诱导:静注1.5mg/kg丙泊酚及芬太尼4μg/kg。麻醉维持:丙泊酚7mg/(kg·h)。肌松监测采用加速度法四个成串刺激(TOF),测定和记录刺激尺神经时拇内收肌的颤搐反应。Li组静注利多卡因1.5mg/kg,C组静注等量生理盐水,2min后静注罗库溴铵0.6mg/kg,待TOFT1抑制95%时行气管插管。记录肌松起效时间(注药结束至TOF的T1肌颤搐抑制95%的时间)及气管插管条件。结果肌松起效时间:C组与Li组分别为(84.70±28.28)s、(68.30±23.46)s,Li组显著快于C组(P<0.05)。气管插管条件:Li组显著优于C组(P<0.05)。诱导前、插管前两组间SBP、DBP、HR均无显著性差异(P>0.05)。结论利多卡因可显著缩短罗库溴铵肌松起效时间、改善气管插管条件,是罗库溴铵用于快速顺序诱导气管插管时有效的辅助药物。

Objective To investigate the effects of intravenous lidocaine pretreatment on onset time ofrocuronium-induced neuromuscular block. Methods Sixty ASA Ⅰ or Ⅱ male patients aged 18-49 yrs weighing 41-82kg undergoing elective surgery under general anesthesia were randomly divided into 2 groups （ n=30 each ）： group lidocaine （Li） and group control （C）. Anesthesia were induced with propofol 1.5mg/kg and fentanyl 4μ g/ kg and maintained with continuous infusion of propofol 7mg/kg/h. Neuromuscular function was monitored and recorded using acceleromyography （TOF-WATCH？ SX, Organon, the Netherlands）, The twitch response to train-of-four （TOF） stimulation of adductor pollicis muscle via ulnar nerve was measured and recorded. An intravenous bolus of lidocaine 1.5mg/kg was given to group Li while the equivalent volume of normal saline （NS） to group C. Two minutes later rocuronium 0.6 mg/kg was injected as a bolus and intubation was facilitated while the first twitch （T1） of TOF was inhibited to 95%. The rocuronium onset time （from the end of injection Of rocuronium until 95% depression of T1） and tracheal intubating conditions were recorded. Results The onset time of neuromuscular block induced by rocuronium in group Li was 68.30±23.46s compared with 84.70±28.28s in group C, which was significantly faster （P〈0.05）. The intubating conditions in group Li were significantly better than in group C（P〈0.05）. There were no significant differences in SBP, DBP, HR at preinduction and preintubation between the two groups（P〉0.05）. Conclusion Intravenous lidocaine pretreatment shortens the onset time of rocuronium, improves endotracheal intubating conditions. Lidocaine is an effective ancillary drug for rocuronium-induced tracheal intubation.