麻醉肌松药在大面积烧伤患者的临床应用

Application of amine Cis-atracurium in patients with extensive burns

目的:了解肌松药在大面积烧伤患者中的应用效果及用量变化,以期对临床麻醉用药的应用提供参考依据。方法:选取2010年4月～2011年5月期间住院的烧伤患者62例作为观察组,同期在骨科住院的患者60例作为对照组,观察麻醉肌松药在大面积烧伤患者中的临床应用。结果:烧伤组第2次及第3次削切痂植皮顺式阿曲库铵的用量与对照组及第1次削切痂植皮比明显增加(P<0.05);比较各次手术时间均无统计学差异(均P>0.05)。烧伤组起效时间比对照组明显延长,维持时间比对照组明显缩短(P<0.05)。但烧伤组内比较可以看出起效时间随着切痂制皮次数增加而延长,维持时间逐渐缩短,但是差异无统计学意义(P>0.05)。结论:烧伤患者对非去极化肌松药的敏感性下降,产生耐药性,导致阿曲库铵用量增加,同时起效时间延长,维持时间缩短,因此临床麻醉工作中一定要注意选择合适的麻醉方案,使肌松药最好的发挥其药效。

Objective： To investigate the clinical effects of non-depolarizing muscle relaxant in extensive burns patients.Methods： A total of 62 burn patients that were admitted to our hospital during April,2010 to May,2011 were enrolled as observation group,and 60 traumatic osteopathic patients that hospitalized during the same period were selected as control group.The effects of amine Cis-atracurium was observed in two groups.Results：The amine cis-atracurium dosage was increased apparently during the second and third anesthesia for multiple crest exeisions（plus grafting） comparing with the dosage used during the first time（P0.05）.No significant difference in operation time was observed among the three groups（P0.05）.In burns group,the onset time of neuromuscular blockade of amine cis-atracurium was significantly extended the clinical duration was significantly shortened compared with the control group（P0.05）.For burn patients,onset time of neuromuscular blockade of amine cis-atracurium extended and duration of effectiveness shortened as the excision times increased,but no significant difference was observed（P0.05）.Conclusions：Dosage of amine cis-atracurium should be increased for burn patients since they are not sensitive to amine cis-atracurium,the onset time of neuromuscular blockade of amine cis-atracurium is extended,and duration of effectiveness is also shortened.Therefore,appropriate anesthesia options are very important in order to make the muscle relaxants to play its efficacy best.