吸入不同浓度和时间七氟醚对阿曲库铵肌松效应的影响

Effects of Different Concentration and Time Course of Sevoflurane on Muscular Relaxation by Atracurium

目的：研究吸入不同浓度和时间七氟醚对阿曲库铵肌松效应的影响。方法：５０例ＡＳＡⅠⅡ级，头、颈和面部择期手术病人，年龄１８～６４岁，根据吸入七氟醚的浓度和时间随机分为五组：Ｉ组５０％Ｎ２Ｏ１５ｍｉｎ，Ⅱ组、Ⅲ组１％七氟醚５０％Ｎ２Ｏ１５ｍｉｎ、３０ｍｉｎ，Ⅳ组、Ⅴ组１．５％七氟醚５０％Ｎ２Ｏ１５ｍｉｎ、３０ｍｉｎ。用加速度仪以四个成串刺激（ＴＯＦ）监测静注阿曲库铵０．５ｍｇ／ｋｇ后的神经肌肉功能。结果：阿曲库铵的起效时间各组间有显著性差异（Ｆ＝４．１４，Ｐ＜０．０１），Ｖ组（１．４８±０．４３ｍｉｎ）短于Ｉ组（２．２７±０．７３ｍｉｎ）和Ⅱ组（２．２８±０．３８ｍｉｎ）（Ｐ＜０．０５）。临床维持时间、２５％与７５％恢复时间，Ⅲ、Ⅳ组长于Ｉ组（Ｐ＜０．０５），Ⅴ组也长于Ⅰ、Ⅱ组（Ｐ＜０．０５）。恢复指数，ＩＶ组（１６．６０±３．６３ｍｉｎ）和Ｖ组（１８．５３±５．２８ｍｉｎ）显著长于Ｉ组（１１．２２±３．４９ｍｉｎ）（Ｐ＜０．０５）。结论：七氟醚能明显增强阿曲库铵的肌松效应，且随着吸入浓度的增加及持续时间的延长，可使阿曲库铵的起效时间缩短。

Purpose: To investigate the effects of different concentration and time course of sevoflurane on muscular relaxation by atracurium. Methods: Fifty patients (ASA Ⅰ Ⅱ) aged 18～64 years performed surgical procedures on head or neck or faces, were divided into five groups of ten each at random. Group 1: inhalated 50%N 2O/O 2 for 15 min, Group 2: inhalated 1% sevoflurane in 50 N 2O for 15 min; Group 3:inhalated 1% sevoflurane in 50% N 2O for 30 min; Group 4: inhalated 1.5% sevoflurane in 50% N 2O for 15 min; Group 5: inhalated 1.5% sevoflurane in 50% N 2O for 30 min. Accelerometer was employed to detect neuromuscular function with train of four stimulation after intravenation of atracurium at 0.5 mg/kg. Results: The effectual time of atracurium showed significant difference among these groups( F =4.14, P <0.01),and in group 5(1.48±0.43 min), it was shorter than that of group 1(2.27±0.73 min) or group 2(2.28±0.38 min) ( P <0.05). The clinical duration, the 25% recovery time and the 75% recovery time were longer in group 3 and group 4 than those in group 1( P <0.05). In group 5, they were also longer than those in group 1 and group 2( P <0.05). The recovery indexes of group 4 and group 5 were markedly longer than that of any other group( P <0.05).Conclusion: Sevoflurane could obviously enhance the effect on muscular relaxation by atracurium. With the concentration being increased and the time course being prolonged, the effectual time of atracurium become shorter and the clinical duration and the recovery time become longer.