维库溴铵前处理对琥珀胆碱肌震颤及插管条件的影响

Effects of vecuronium pretreatment on the muscle tremors and intubating conditions of succinylcholine

目的探讨维库溴铵前处理既能有效抑制琥珀胆碱的肌震颤又对气管插管条件影响较小的最佳剂量。方法 100例择期手术全麻患者采用随机数字表法分为5组,每组各20例。Ⅰ组不用维库溴铵（对照组）,其他4组（试验组）全麻诱导前2分钟静脉预注维库溴铵,剂量为Ⅱ组0.01 mg/kg,Ⅲ组0.02 mg/kg,Ⅳ组0.03 mg/kg,Ⅴ组0.04 mg/kg。观察各组肌震颤分级和气管插管条件分级。结果Ⅰ~Ⅳ组肌震颤发生率分别为100%、90%、15%、15%、10%;Ⅰ组有11例发生强烈的肌震颤,其他4组均无强烈的肌震颤发生;Ⅰ、Ⅱ组之间,Ⅲ、Ⅳ、Ⅴ组之间的肌震颤发生率比较,差异均无统计学意义（P〉0.05）;Ⅲ、Ⅳ、Ⅴ组肌震颤发生率及程度明显低于Ⅰ、Ⅱ组,差异均有统计学意义（P〈0.01）;Ⅰ~Ⅳ组分别有100%、95%、90%、55%、10%患者插管条件达3、4级;Ⅱ、Ⅲ组气管插管条件与Ⅰ组相比,差异均无统计学意义（P〉0.05）;Ⅳ、Ⅴ组气管插管条件均明显差于Ⅰ、Ⅱ、Ⅲ组,差异均有统计学意义（P〈0.01）。结论 0.02 mg/kg维库溴铵前处理既能有效抑制琥珀胆碱产生的肌震颤,又对气管插管条件无明显影响,是维库溴铵前处理的最佳剂量。

Objective To Study the optimal dose of vecuronium pretreatment,which can effectively inhibit the muscle tremors of succinylcholine and has little effect on intubating conditions.Methods 100 patients under going elective surgical anesthesia were randomly divided into five groups,each of the 20 cases.groupⅠwithout vecuronium（control group）,the other four groups（experimental group）2 min before induction of anesthesia intravenous pre-injection of vecuronium,groupⅡ 0.01 mg/kg,group Ⅲ 0.02 mg/kg,group Ⅳ0.03 mg / kg,group Ⅴ0.04 mg/kg.Observed muscle tremor classification and grading intubation conditions.Results The patients in groupⅠhad all muscle tremors,11 cases of strong muscle tremor,the patients in other four groups had no strong muscle tremor.The incidence rate of muscle tremors was no significant different between groupsⅠand Ⅱ or among groups Ⅲ,Ⅳ and Ⅴ（P0.05）,the incidence rate and degree of muscle tremor in groups Ⅲ,Ⅳ and Ⅴ were significantly lower than that in groupⅠand Ⅱ（P0.01）.In comparison with groupⅠ,the intubating conditions in groups Ⅱand Ⅲ were no significant different（P0.05）,the intubating conditions in groups Ⅳand Ⅴ were significantly worse than that in groups Ⅰ,Ⅱand Ⅲ（P0.01）.Conclusion 0.02 mg/kg vecuronium pretreatment can effectively inhibit the muscle tremors of succinylcholine,and has no significant effect on intubating conditions,which is the best pre-treatment dose.