全身热疗对全凭静脉麻醉下阿曲库铵肌松效应的影响

The effects of whole-body hyperthermiaon pharmacodynamics of atracurium under total intravenous anesthesia

目的 观察全身热疗（whole body hyperthhermia，WBH）对晚期癌症患者全凭静脉麻醉（total intravenous anesthesia，TIVA）中阿曲库铵用量和作用时间的影响。方法 晚期癌症TIVA患者，分非高温组（24例），高温组（26例）。监测两组患者的体温、心电图（ECG）、中心静脉压（CVP）、脉搏血氧饱和度（SpO2）、pH值，呼气末二氧化碳分压（PEIcO2）等；记录各组阿曲库铵用量。监测停止输注阿曲库铵时，4个成串刺激（train of four，TOF）从10％恢复至25％、50％、75％平均时间。结果 与非高温组阿曲库铵用量（73．2±9．5）mg／kg、平均泵速（5．1±O．9）μg·kg^-1·min^-1比较，高温组阿曲库铵用量为（123．8±15．7）mg／kg VS（73．2±9．5）mg／kg（P〈O．01），平均泵速（12．5±1．7）μg·kg^-1min^-1vs（5．1±0．9）μg·kg^-1·min^-1（P〈O．01）。非高温组，TOF从10％恢复至25％、50％、75％的时间分别为（8．2±2．5）min，（13．8±2．3）min，（24．1±3．7）min；高温组，TOF从10％恢复至25％、50％、75％的时间分另0为（4．8±1．3）minVS（8．2±2．5）min（P〈0．01），（8．6±1．7）minVS（13．8±2．3）min（P〈0．05），（14．1±3．2）minVS（24．1±3．7）min（P〈0．01）.结论 WBH可以增加晚期癌症患者TIVA中阿曲库铵的用量和输注速度，缩短其作用时间。

Objective To observe the effects of whale-body hyperthermia （WBH）on pharmacodynamics of atracurium in patients with malignant tumor under total intravenous anesthesia. Methods Fifty patients with advanced cancer were randomly assigned into two groups, hyperthermia group （n=24）and non-hyperthermia group （n=26）. Parameters such as body temperature, electrocardiogram（ECG）, central venous pressure （CVP）, pulse oxygen saturation （SpO2）and endridal CO2（PETCO2） were monitored during the operation. The train of four （TOF） mode of stimulation was used to monitor neuromuscular blocking. The dosages of atracurium were recored. The TOF on the time of atracurium withdrawal and the time of 25 %, 50 %, 75 % recovery from 10% of TOF were recorded. Results The dosage of atracurium in hyperthermia group was higher than that of non hyperthermia group （123.8±15.7） mg/kg vs （73.2±9.5） mg/kg（P〈O.O1 ）. The infusion speed of atracurium in hyperthermia group was faster than that of non hyperthermia froup （12.5±1.7） μg^-1kg^-1min^-4 vs （5.1±0.9） μg＇kg^-l.min^-1（P〈O.O1）. The 25%, 50%, 75% of TOF recovery from 10% of TOF in non- hyperthermia group were （8.2±2.5）, （13.8±2.3）, （24.1±3.7） min, respectively. The 25% ,50%,75% of TOF recovery from 10% of TOF in hyperthermia group were（4.8±l.38）,（6±l.7）,（14.1±3.2）, respectively. Conclusion WBH increases the consumption and infusion speed of atracurium and shortens the acting time of atraeurium.