预注肌松药在全身麻醉下气管内插管术的应用

Application of different priming dose of muscle relaxant in endotracheal intubation and general an-esthesia

目的观察预注不同剂量肌松药在全身麻醉下气管内插管术的影响。方法ASAⅠ-Ⅱ级择期手术患者120例随机分为6组（n=20），分别为维库溴铵组（V1, V2, V3 ）和顺式阿曲库铵组（C1, C2, C3），其中V1、C1为对照组，V2、V3、C2、C3为预注组。所有患者给予丙泊酚血浆TCI3μ∥ml，芬太尼3Cg／kg全麻诱导后，对照组：V1、C1分别静注2倍ED95剂量维库溴铵和3倍ED95剂量顺式阿曲库铵。预注组：V2、V3、C2、C3分别预注10、20μg／kg维库溴铵和15、30oμg／kg顺式阿曲库铵，待肌松起效后给予剩余的插管剂量肌松药。观察肌松起效时间（T1=0）、气管插管条件。结果6组的气管插管优良率均为100％。预注组V2、V3、C2、C3的起效时间（T1=0）明显缩短[（80．5±7．2）VS（146±10．7）；（79．84-6．5）VS（1464-10．7）；（138．5±7．2）VS（218±10．7）；（127．1±6．5）VS（218±10．7）]。差异有统计学意义（P〈0．05）。结论预注不同剂量肌松药能显著缩短起效时间，加大预注量并不能进一步缩短肌松药的起效时间。

Objective To study the effects of different priming dose of muscle relaxant at the onset and endotracheal intubation conditions. Methods 120 ASA Ⅰ-Ⅱgrade patients were randomly divided into 6 groups （ n -6）, vecuronium group （ V1, V2, V3 ） and cis-atracurium group （ C1, C2, C3 ）. All patients were induced with propofol plasma （TCI）3 tLg/ml,fentanil3 trg/kg. The Vt and C1 group were not givenpriming dose, and the V2, V3, C2, C3 groups were given priming dose of 10 μg/kg,20μg/kg vecuronium and 15 μg/kg,30 μg/kg cis-atracurium. Intubating conditions were evaluated, and the onset time was mo- nitored with train-of-four （TOF） technique. Results Intubating conditions were excellent in all patients. The onset time of priming groups of the four different doses was significantly shorter than that of the nonprim- ing group [（80.5 ±7.2） vs （146±10.7）;（79.8±6.5） vs （146±10.7）;（138.5±7.2） vs （218± 10. 7 ） ; （ 127. 1 ± 6. 5） vs （218 ± 10. 7）, P 〈 0. 05 ]. Conclusions The taking-effect time of priming dose of muscle relaxant was significantly shorter than that of the nonpriming dose group. Increasing the priming dose not decrease onset time more than the smaller dose.