动脉血二氧化碳分压对罗库溴铵肌松恢复和拮抗效果的影响

Effects of arterial carbon dioxide on recovery from rocuronium bromide-induced neuromusuclar blockade and the antagonism of neostigmine

目的观察动脉血二氧化碳分压(paCO2)对罗库溴铵肌松恢复和拮抗效果的影响。方法选择60例美国麻醉医师学会(ASA)分级为Ⅰ～Ⅱ级,择期于全身麻醉下行妇科手术的成年患者,随机分为4组,每组15例。Ⅰ组为低paCO2(paCO2控制目标为30～35mmHg,1mmHg=0.133kPa),肌松自然恢复;Ⅱ组为高paCO2(paCO2控制目标为45～50mmHg),肌松自然恢复;Ⅲ组为低paCO2,拮抗肌松;Ⅳ组为高paCO2,拮抗肌松。应用TOF-Watch加速度仪监测肌松情况。予丙泊酚、芬太尼和罗库溴铵0.6mg/kg行全身麻醉诱导气管插管,术中当肌松监测仪4个成串刺激(TOF)中第1个刺激(T1)恢复至25%时即追加罗库溴铵0.15mg/kg。术毕记录T1自25%恢复至75%的时间及T1自25%至TOF中第4个肌颤搐与第1个肌颤搐的比值(TOFR)为0.9的恢复时间。拮抗组在T1为25%时予新斯的明20μg/kg和阿托品0.5mg拮抗。结果 4组间年龄、体质指数、麻醉药用量、麻醉持续时间、血流动力学变化的差异均无统计学意义(P值均>0.05)。Ⅰ、Ⅱ、Ⅲ及Ⅳ组的T1自25%恢复至75%的时间分别为(13.12±2.65)、(18.60±6.58)、(5.39±2.43)和(8.87±5.41)min,T1自25%至TOFR0.9的恢复时间分别为(26.35±6.04)、(34.58±6.58)、(13.28±5.49)和(17.10±4.64)min。Ⅱ组的T1自25%恢复至75%的时间及T1自25%至TOFR0.9的恢复时间均较Ⅰ组显著延长(P值均<0.01),Ⅳ组的T1自25%恢复至75%的时间及T1自25%至TOFR0.9的恢复时间均较Ⅲ组显著延长(P值均<0.05)。结论 paCO2升高使罗库溴铵的自然恢复和小剂量新斯的明拮抗后的恢复时间均有延长。

Objective To investigate the effects of the arterial blood carbon dioxide on the recovery from rocuronium bromide-induced neuromusuclar blockade and the antagonistic effect of neostigmine.Methods Sixty patients of American Society of Anesthesiologists（ASA）grade Ⅰ-Ⅱ undergoing selective gynecology operation under general anesthesia were randomly divided into four groups（n=15 each）：group Ⅰ（low pressure of arterial carbon dioxide [paCO2] 30-35 mmHg,1 mmHg=0.133 kPa,spontaneous recovery from neuromusuclar blockade induced by rocuronium）;group Ⅱ（high paCO2,45-50 mmHg,spontaneous recovery）;group Ⅲ（low paCO2,antagonizing neuromusuclar blockade induced by rocuronium with neostigmine）;and group Ⅳ（high paCO2,antagonizing）.Neruomuscular blockade was evaluated by train-of-four（TOF）-Watch accelerograph.General anesthesia was induced with intravenous propofol,fentanyl and rocuronium（0.6 mg/kg）.When T1 recovered to 25%,rocuronium（0.15 mg/kg）was injected.After the operation,the residual neuromuscular blockade was antagonized with atropine（0.5 mg）and neostigmine（0.02 mg/kg）in antagonism groups when the T1 reaching 25%.The recovery periods of T1 from 25% to 75%（recovery index）and to train-of-four ratio（TOFR）0.9 were recorded.Results There were no significant differences among four groups with respect to age,body weight,height,body mass index,total consumption of anesthetics,anesthesia duration or hemodynamic parameters.The recovery indices in the four groups were（13.12±2.65）,（18.60±6.58）,（5.39±2.43）,and（8.87±5.41）min,respectively.The recovery periods from T1 25% to TOFR 0.9 were（26.35±6.04）,（34.58±6.58）,（13.28±5.49）and（17.10±4.64）min,respectively.The recovery index and recovery time period in group Ⅱ were significantly longer than those in group Ⅰ（both P0.01）,and those in group Ⅳ were significantly longer than those in group Ⅲ（both P0.05）.Conclusion The elevated arterial carbon dioxide can prolong the spontaneous recovery of neuromuscular blockade induced by rocuronium bromide and the recovery after antagonizing with small doses of neostigmine.