不同浓度七氟醚对阿曲库铵药效学的影响

The effects of different concentration of sevoflurane on the pharmacodynamics of atracurium

目的：观察吸入不同浓度七氟醚对阿曲库铵肌松效应的影响。方法：３０例ＡＳＡ－Ⅱ级，头、颈和面部择期手术患者，年龄１８～６４岁。根据吸入不同浓度的七氟醚随机分为三组，Ⅰ组吸入５０％Ｎ２Ｏ１５ｍｉｎ，Ⅱ组吸入１％七氟醚－５０％Ｎ２Ｏ１５ｍｉｎ、Ⅲ组１．５％七氟醚－５０％Ｎ２Ｏ１５ｍｉｎ。用加速度仪以四个成串刺激（ＴＯＦ）监测神经－肌肉功能，记录静注阿曲库铵０．５ｍｇ／ｋｇ后肌松起效时间、临床维持时间、Ｔ１恢复至２５％、７５％时间和恢复指数。结果：阿曲库铵的起效时间Ⅲ组（１．７１±０．４８）ｍｉｎ短于Ⅰ组（２．２７±０．７３）ｍｉｎ和Ⅱ组（２．２８±０．３８）ｍｉｎ（Ｐ＞０．０５）；临床维持时间、２５％与７６％恢复时间Ⅲ组长于Ⅰ组（Ｐ＜０．０５）和Ⅱ组（Ｐ＞０．０５）；恢复指数Ⅲ组（１６．６０±３．６３）ｍｉｎ与Ⅰ组（１１．２２±３．４９）ｍｉｎ比较差异有显著性意义。结论：本研究表明，七氟醚能增强阿曲库铵的临床药效，且与其剂量呈正相关。随着吸入七氟醚浓度的增加，可使阿曲库铵的起效时间缩短，维持及恢复时间明显延长。

Objective:To observe the effects of different concentration of sevoflurane on the pharmacodynamics of atracurium.Methods: Thirty patients with ASA Ⅰ-Ⅲ undergoing head, neck or face elective surgical procedures, were randomly divided into three groups. They were anaesthetized to receive 50% N 2O for 15 min (group Ⅰ, n =10), 1% end tidal concentration of sevoflurane in 50% N 2O for 15 min (group Ⅱ, n =10) and 1.5% end tidal concentration of sevoflurane in 50% N 2O for 15 min (group Ⅲ, n =10), respectively. Following atracurium 0.5 mg·kg 1- was intravenously adimnistered by bolus injection, neuromuscular function was recorded by Accelography in response to train of four stimulation.Results: The onset time of atracurium was shorter in group Ⅲ (1 71±0 48 min) than in group Ⅰ (2 27±0 73 min) and group Ⅱ (2 28±0 38 min) ( P >0 05). While the clinical duration, the 25% and 75% recovery time were longer in group Ⅲ than in group Ⅰ ( P <0 05) and group Ⅱ ( P >0 05). The recovery index was significantly prolonged in group Ⅲ (16 60±3 63 min) than group Ⅰ (11 23±3 49 min, P <0 05). Blood pressure and heart rate were stable after intravenous atracucrium. Conclusion: This study indicates that sevoflurane may significantly enhance the neuromuscular blockade effect of atracurium. Along with the increasing of sevoflurand inhalation concentration, the onset time of atracurium is shortened and the clinical duration of action is significantly prolonged.