麻黄素和急性扩容对顺式阿曲库铵起效时间及循环功能的影响

Effects of ephedrine and acute expansion on Atracurium cisatracurium-onset time and circulatory function

目的探讨麻黄素急性扩容对顺式阿曲库铵起效时间以及循环功能影响。方法择期上腹部手术全麻患者40例,患者随机分为4组,对照组(C),麻黄素组(E),麻黄素+容量治疗组(EV),单纯容量治疗组(V),每组各10例。各组患者均在桡动脉和中心静脉穿刺,并在外周静脉以TCI(target controlled infusion)靶浓度为3μg/ml丙泊酚连续输注10 min后测定平均动脉压(mean arterial pressure,MAP)、心排血量(cardiac output,CO)、心率(heart rate,HR)和周围血管阻力(systemic vascular resistance,SVR),并作为基础值,EV组和V组在快速扩容完成后稳定10min,并分别注射麻黄素70μg/kg和生理盐水5 m1,C组和E组分别注射生理盐水5 ml和麻黄素70μg/kg,各组在其后1、2、3min连续监测循环指标。各组均在给药1min后给予芬太尼2μg/kg,顺式阿曲库胺0.1mg/kg(2ED95),药物均在30s内注射完毕。结果 E组和C组的SVV(stroke volumevarication)显著低于EV组和V组的(P<0.05);顺式阿曲库铵的起效时间,EV组的显著低于其他组的(P<0.05)。结论快速扩容后复合使用麻黄素能显著缩短顺式阿曲库铵的起效时间。

Objective To investigate the effects of ephedrine and acute expansion on the onset time of cisatracurium and the circulatory function. Methods Forty patients undergoing elective major upper abdominal surgery were randomly divided into 4 groups： control group （C）, ephedrine group （E）, ephedrine combined with volume therapy group （EV） and pure volume therapy group （ V ）, with 10 patients in each group. All patients were punctured at the center of the radial artery and vein, and continuously infused with propofol at target controlled infusion （TCI） concentration （3 μg/ml） into peripheral vein for 10 rain. Then measurement was taken of mean arterial pressure （MAP）, cardiac I output（CO）, heart rate （HR） and systemic vascular resistance （SVR）. Patients in group EV and V were injected with ephedrine 70 μg/kg, and saline 5 ml after rapid expansion. Patients in group C and E were injected with 5 ml saline solution, and 70 μg/kg ephedrine, respectively. In the next 1 min, 2 min and 3 min, measurements of MAP, CO, HR and SVR were continuously monitored. After 1 min, patients in each group were injected 2μg/kg fentanyl and 0.1 mg/kg （2ED95） cisatracurium within 30 s. Results Stroke volume variation （SVV） of group E and group C were significantly lower than that of group EV and group V （ P 〈 0.05 ）. The onset time of cisatracurium of group EV was significantly lower than that of other groups （ P 〈 0. 05 ）. Conclusion The application of ephedrine after rapid expansion can significantly shorten the onset time of cisatracurium.