罗库溴铵不同预注射间期对顺式阿曲库铵时效的影响

Effects of priming with rocuronium on time course characteristics of cisatracurium: a comparison of different priming intervals

目的研究罗库溴铵不同预注射间期对顺式阿曲库铵起效、恢复时间及插管条件的影响。方法选择气管插管全身麻醉下行择期手术的患者150例,年龄18~56岁,美国麻醉医师学会（ASA）分级Ⅰ~Ⅱ级,随机分为5组（A、B、C、D和E组）,每组30例。先采用芬太尼及丙泊酚麻醉诱导,入睡后应用肌松监测仪对尺神经进行连续4个成串刺激（TOF）,观察拇内收肌肌颤搐的程度。A、B、C和D组均先预注射罗库溴铵0.09 mg/kg[30%的95%有效药物剂量（ED95）],分别间隔1、2、3和6 min静脉注射顺式阿曲库铵0.15 mg/kg[3倍ED95]。E组为对照组,麻醉诱导后仅静脉注射顺式阿曲库铵0.15 mg/kg。当TOF的第1个肌颤搐反应幅度（T1）与肌颤搐对照值（Tc）的比值（T1/Tc值）〈10%时行气管插管。麻醉维持用七氟烷吸入,必要时间断静脉注射芬太尼。记录预注射间期末T1/Tc值和TOF的第4个肌颤搐反应幅度（T4）与T1的比值（TOFR）、起效时间、气管插管条件评级、临床肌松维持时间和临床肌松有效作用时间。结果与E组相比,A、B、C、D组临床肌松起效时间显著缩短（P值均〈0.05）,但临床肌松维持时间和有效作用时间均显著延长（P值均〈0.05）;其中,B、C组起效时间显著短于A、D组（P值均〈0.05）,而B与C组间起效时间的差异无统计学意义（P〉0.05）;D组临床肌松维持时间显著长于其他预注射组（P值均〈0.05）,临床肌松有效作用时间显著长于A组（P〈0.05）。C组在预注射间期末T1/Tc值和TOFR均显著低于A、B、D组（P值均〈0.05）。各组间气管插管条件评级的差异无统计学意义（P〉0.05）。结论预注射30%ED95罗库溴铵能使顺式阿曲库铵起效时间缩短,恢复时间延长,其最佳预注射间期是2 min。

Objective To study the effects of priming with rocuronium at different priming intervals on the onset time,recovery time and intubation conditions of cisatracurium.Methods A total of 150 patients of American society of anesthesiologists（ASA） physical status Ⅰ—Ⅱ,who were scheduled for elective surgery and required endotracheal intubation,were randomized into five groups（30 patients each）.After induction with propofol and fentanyl,rocuronium was administered at 0.09 mg/kg to Group A,B,C and D as priming doses.After four different priming intervals（Group A 1 min,Group B 2 min,Group C 3 min and Group D 6 min）,intubation doses of cisatracurium 0.15 mg/kg were given.Only cisatracurium 0.15mg/kg was administered after induction to Group E（control group）.First twitch height percentage（T1/Tc%） and train-of-four ratios（TOFR,T4/T1%） were recorded every 12 seconds before the initial priming dose.Intubation was attempted after T1/Tc became less than 10% of baseline.T1/Tc and TOFR at the end of priming intervals,the onset time of cisatracurium,intubation conditions,the duration of peak effect（time from cisatracurium administration to 5% recovery of T1） and the duration of clinical action（time from cisatracurium administration to 25% recovery of T1） were observed.Results Compared with the control group,the onset time of cisatracurium in the four priming groups was significantly shorter（P0.05）,the durations of peak effect and clinical action were significantly longer（P0.05）.T1/Tc and TOFR of Group C were depressed significantly at the end of priming intervals compared with the rest 3 groups（P0.05）;the onset times of Group B and C were significantly shorter than those of Group A and D（P0.05）,the duration of peak effect in Group D were longer than those in the other 3 groups（P0.05）,the duration of clinical action of Group D was longer than Group A（P0.05）.Intubation conditions were similar among the five groups（P0.05）.Conclusion Rocuronium can accelerate the onset of cisatracurium and prolong the recovery time.When the priming dose of rocuronium is 30% ED95,the optimal priming interval is 2 min.