持续输注国产顺式阿曲库铵在全身麻醉中肌松作用的研究

Effect on muscle relaxant of continuous infusion of domestic cisatracurium in general anesthetic

目的:探讨持续输注国产顺式阿曲库铵在给药方法的可能性及平均输注速度,为其在全身麻醉中的应用提供参考。方法:择期行胃癌根治术且全凭静脉全麻患者33例,ASAⅠ～Ⅱ级,无神经肌肉系统疾病病史,肝肾功能正常。随机分为A,B,C三组。采用HXD-1C028型加速度肌松检测仪对尺神经进行单次颤搐刺激,监测拇内收肌肌颤搐抑制情况。麻醉诱导以静注异丙酚和舒芬太尼,病人入睡后开启肌松监测仪,静脉注射顺式阿曲库铵0.15mg/kg,待单次颤搐抑制75%时气管插管,机械通气。术中维持:持续输注异丙酚6-10mg.kg-.1h-1和舒芬太尼0.2tig.kg-.1h-1,以及顺式阿曲库铵A组(1μg)B组(2μg)C组(3μg)各组。术中肌松不满意时追加顺式阿曲库胺5mg/次。缝合腹膜及腹直肌前鞘后全部停止输注所有药物,此后任其自然恢复,不予任何拮抗药。待病人完全恢复(潮气量大于400ml且能够呼之睁眼并持续抬头5秒以上)即可常规吸痰拔除气管导管。记录气管插管条件;顺式阿曲库胺追加次数;手术时间,术中肌颤搐最大抑制程度,恢复指数,临床作用时间,拔管时间;顺式阿曲库胺用药总量。结果:与B、C组比较,A组术中肌颤搐最大抑制程度降低,明显增加术中顺阿曲库铵追加次数并影响拔管时间(P<0.01);与B组比较,C组顺阿曲库铵用药总量明显增加,临床作用时间延长,但肌松效果相似无统计学意义(P<0.05)。结论:在胃恶性肿瘤术中持续输注顺式阿曲库铵可维持满意的肌松并有助于手术后肌张力迅速恢复,减轻麻醉医生工作量,但以2μg.kg-1.min-1为宜。

Objective：To explore continuous infusion of domestic cisatracurium method,the possibility and the average infusion rate in order to provide reference for general anaesthesia. Methods： 33 cases of undergoing radical operation for gastric cancer with total intravenous anesthesia, ASA Ⅰ-Ⅱ, no history of diseases of the nervous system, normal liver and kidney function were randomly divided into A, B and C group. Ulnar nerve was performed single twitch stimulation by HXD-I C028 acceleration muscle relaxation tester,in which the adductor pollicis muscle twitch inhibition was monitored. Induction of anesthesia was intravenous pmpofol and sufentanil. When patients with sleep, muscle relaxation monitor was opened, intravenously injecting domestic cisatracurium 0.15mg/kg was performed,and endotracheal intubation and mechanical ventilation was performed staying single twitch inhibition of 75%. Intraoperative maintenance：continuous infusion of propofol and sufentanil in 6-10mg·kg^-1·h^-1,0.2tig·kg^-1·h^-1, as well as the domestic cisatracurium group A（1μg）,B（2μg）and C（3μg）. Additional domestic cisatracurium 5mg/time was given when intraoperative muscle relaxation was not satisfied. All drugs were stoped infusion when suturing peritoneum and rectus abdominis anterior, then there was not give any antagonists with natural recovery. Tracheal catheter was removed with conventional aspiration of sputum when patients recovered completely（tidal volume was greater than 400ml and can call the goggle and continued to rise more than 5 seconds）. Tracheal intubation conditions, domestic cisatracurium additional number, operation time, intraoperative muscle twitch maximum degree of inhibition, recovery index, clinical effect of time, extubation time and domestic cisatracurium drug aggregates were recorded. Results： Compared with B and C group,maximum inhibition degree of intraoperative muscle twitch reduced and obviously increased the number of additional domestic cisatracurium dose effecting extubation time （P〈0.01） in A group; compared with B group,domestic cisatracurium dose and clinical role of time increased,but muscle relaxant effect was not statistically significant （P〈0.05） in C group. Conclusion： Intraoperative continuous infusion of domestic cisatracurium in gastric malignant can maintain satisfactory muscle relaxants and contribute to recover quickly muscle tones and reduce anesthesia doctors＇ workload in which 2μg/（kg· min） is appropriate.