诱导使用罗库溴铵和顺式阿曲库铵的药效学研究

Pharmacodynamic Study on Cisatracurium and Rocuronium

目的观察预注罗库溴铵或顺式阿曲库铵对顺式阿曲库铵气管插管肌松起效时间的影响和麻醉维持期罗库溴铵对顺式阿曲库铵药效学的影响。方法 160例择期全麻手术患者随机分为4组:麻醉诱导期,Ⅰ组(顺式阿曲库铵插管剂量组)静注顺式阿曲库铵0.15mg·kg-1,Ⅱ组(罗库溴铵预注组)先静注罗库溴铵0.09mg·kg-1,3min后静注顺式阿曲库铵0.135mg·kg-1,Ⅲ组(顺式阿曲库铵预注组)先静注顺式阿曲库铵0.015mg·kg-1,3min后静注顺式阿曲库铵0.135mg·kg-1,Ⅳ组(罗库溴铵插管剂量组)静注罗库溴铵0.9mg·kg-1,麻醉维持期4组患者均静注顺式阿曲库铵0.03mg·kg-1。肌肉松弛度监测,观察肌松起效时间、"四个成串"电刺激(TOF)比值恢复至25%、75%的时间,计算恢复指数。结果Ⅱ和Ⅲ组患者气管插管肌松起效时间明显短于Ⅰ组,但长于Ⅳ组(P<0.05)。且Ⅳ组女性患者肌松起效时间明显短于男性患者(P<0.05);Ⅳ组高龄患者麻醉诱导期肌松持续时间明显长于青壮年患者(P<0.05);Ⅳ组患者麻醉维持期首次和末次追加顺式阿曲库铵肌松持续时间明显长于Ⅰ组(P<0.05)。4组患者的肌松恢复指标无显著性差异(P>0.05)。结论预注罗库溴铵或顺式阿曲库铵能够明显缩短顺式阿曲库铵气管插管的肌松起效时间,(诱导期静注)罗库溴铵能够明显延长麻醉维持期顺式阿曲库铵的肌松持续时间。

OBJECTIVE To investigate the effect of a precurarizing dose of cisatracurium and rocuronium with a priming time of 3 min on decreasing the onset time of cisatracurium for tracheal intubation,and determine the duration and recovery profile of maintenance doses of cisatracurium following rocuronium.METHODS A total of 160 patients with ASA Ⅰ-Ⅱ scheduled for elective surgery were randomized into 4 groups.The patients in group Ⅰ received intubation dose of cisatracurium 0.15 mg·kg-1.The partients in group Ⅱ received rocuronium 0.09 mg·kg-1.The patients in group Ⅲ received the patients cisatracurium 0.015 mg·kg-1 as a priming dose,and after a 3 min priming time,intubation doses of cisatracurium 0.135 mg·kg-1 were given to the patients again.The patients in group Ⅳ received intubation dose of rocuronium 0.9 mg·kg-1.Anesthesia for 4 groups were maintained with cisatracurium 0.03 mg·kg-1.Neuromuscular blockade was monitored using acceleromyography.The time for the first twitch height percentage（T1/T0%） reached zero（the onset of cisatracurium） and the evoked EMG to spontaneously return to 25%,75% and the recovery index were obtained.RESULTS GroupⅡand Group Ⅲ significantly accelerated the onset of cisatracurium（P0.05）,but the onset was delayed in group Ⅳ.Females in Group Ⅳ had faster onset of paralysis than males（P0.05）,and old patients in Group Ⅳ had a longer duration of paralysis than young ones（P0.05）.The clinical duration of the first and last maintenance doses（cisatracurium） was prolonged after rocuronium was administered（Group Ⅳ）（P0.05）.Howerer,there were no statistical differences in the recovery index（P0.05）.CONCLUSION Rocuronium and cisatracurium can significantly accelerate the onset of cisatracurium,and the clinical duration and maintenance doses of cisatracurium was prolonged following rocuronium.