盐酸戊乙奎醚对罗库溴铵应用于麻醉诱导时效及恢复情况的影响

Penehyclidine hydrochloride and rocuronium bromide used for induction of anesthesia and the recovery of limitation

目的通过观察盐酸戊乙奎醚或阿托品对不同诱导剂量罗库溴铵的作用时效及恢复情况的影响,为罗库溴铵的临床应用及麻醉诱导气管插管剂量的选择提供一定的临床依据。方法选择全麻下行择期手术患者60例,随机分成三组。Ⅰ组:罗库溴铵2倍95%有效剂量(ED95)剂量组(0.6mg/kg);Ⅱ组:罗库溴铵3倍ED95剂量组(0.9mg/kg);Ⅲ组:罗库溴铵4倍ED95剂量组(1.2mg/kg),每组20例。每组再根据两种不同的麻醉术前药随机分为长托宁组ⅠP组、ⅡP组、ⅢP组和阿托品组ⅠA组、ⅡA组、ⅢA组,每组各10例。ⅠP组、ⅡP组、ⅢP组入室后麻醉诱导前10min静注长托宁1.0mg,ⅠA组、ⅡA组、ⅢA组术前0.5h肌注阿托品0.5mg。记录给药后4个成串刺激(TOF)值、肌颤搐反应数、T1消失时间、最大抑制程度和TOF70%。结果肌松程度:ⅠP组与ⅠA组比较,ⅠP组的肌松程度,即TOF%衰减速率在45s、60s、75s、90s、105s及120s几个时间段显著增快(P<0.01)。ⅡP组与ⅡA组比较,ⅡP组的TOF%衰减速率仅在45s时间段显著增快(P<0.01),余时间段差异无显著性。ⅠA组与ⅡA组比较,ⅠA组的TOF%衰减速率在45s、60s、75s和90s几个时间段的衰减显著较慢(P<0.01);气管插管条件:所有气管插管都一次完成,ⅠP组优秀为9例,良好为1例;ⅠA组优秀为6例,良好为4例,两组比较差异有显著性(P<0.05);恢复指数:ⅠP组的恢复指数较ⅠA组大,差异有显著性(P<0.05)。ⅡP组的恢复指数较ⅡA组大,差异有显著性(P<0.05)。TOF70%:ⅠP组TOF70%与ⅡP组和ⅢP组比较、ⅡP组和ⅢP组的TOF70%、ⅠA组的TOF70%与ⅡA组和ⅢA组比较及ⅡA组和ⅢA组的起效时间差异有显著性(P<0.01)。结论盐酸戊乙奎醚可显著缩短2倍ED95诱导剂量的罗库溴铵的起效时间,并可延长罗库溴铵的恢复指数,即降低罗库溴铵的恢复速率。2倍ED95诱导剂量罗库溴铵合并术前药长托宁可在给药后60s获得满意的气管插管条件。3倍、4倍ED95诱导剂量罗库溴铵可在给药后45s获得满意的气管插管条件。

Objective To observe the impact of penehyclidine hydrochloride or atropine on the time course of effect and recovery situation of different induced doses of rocuronium,to provide some clinical basis for rocuronium in the clinical application and the option of its doses of endotracheal intubation of anesthesia induction.Methods Sixty patients undergoing elective surgery with general anesthesia were randomly divided into three groups with 20 cases in each group. Group I,groupⅡ and group Ⅲ received 2x ED95 （0.6 mg/kg）,3x ED95 （0.9 mg/kg）,and 4x ED95 （1.2 mg/kg） rocuronium respectively. Each group was further assigned to penehyclidine group （PⅠ,PⅡ and P Ⅲ） and atropine group （AⅠ,AⅡ and AⅢ） according to different drugs given before anesthesia （10 cases in each subgroup）. 1.0 mg of penehyclidine was intravenous injected 10 minutes before induction of anesthesia in penehyclidine group,while 0.5 mg of atropine was intramuscular injected 0.5 h preoperative in atropine group. TOF value,the numbers of muscle twitch response,T1 disappearance time,maximum inhibition level and TOF70% after administration were recorded.Results Compared to AI group,the level of muscle relaxation or TOF% decay rate increased significantly faster in time periods of 45 s,60 s,75 s,90 s,105 s and 120 s （P〈0.01） in PI group,however,compared to AⅡ group,TOF% decay rate in PⅡ group increased significantly faster only in the 45 s time period （P〈0.01）. Further comparison indicated that compared to A Ⅱgroup,TOF% decay rate in A I group decayed significantly more slowly in the 45 s,60 s,75 s and 90 s time periods （P〈0.01）. For endotracheal intubation conditions,endotracheal intubation were all once completed,excellent and good intubation cases were 9 and 1 in P I group and 6 cases and 4 in AI group respectively （P〈0.05）. The recovery index in PI group was larger than that in AⅠ group （P〈0.05）. Also,the recovery index in PⅡ group was larger than that in AⅡ group （P〈0.05）. In addition,significant differences in TOF70% were observed between PI group and PⅡ group,P I group and PⅢ group,PⅡ group and PⅢ group,AI group and AⅡ group,A I group and AⅢ group （P〈0.01）. The difference of onset time between AⅡ group and AⅢ group was significant （P〈0.01）.Conclusion Penehyclidine hydrochloride can significantly reduce the onset time of 2 ED95 rocuronium,and prolong the recovery index of rocuronium （lower the recovery rate of rocuronium）. The use of 2 ED95 rocuronium plus preoperative penehyclidine provides satisfactory conditions for tracheal intubation in 60 s. 3 ED95 and 4 ED95 induced dose of rocuronium can provide satisfactory conditions for tracheal intubation in 45 s.