在吸入和静脉麻醉下连续泵注莱库溴铵的肌松作用和安全性

Neuromuscular effects and safety of an intravenous infusion of rapacuronium under inhalation or intravenous anesthesia

目的 研究连续泵注莱库溴铵在地氟醚、七氟醚、异氟醚和异丙酚麻醉下的肌松作用及安全性。方法 80例ASAⅠ～Ⅲ级择期手术病人 ,使用TOF GUARD监测仪监测肌松。麻醉诱导静注异丙酚 1 5～ 3mg kg、芬太尼 1～ 2 μg kg、莱库溴铵 1 5mg kg ,气管插管机械通气。维持麻醉时 ,随机吸入呼气终末浓度为 2 %～ 4%地氟醚、0 75 %～ 1 5 %七氟醚或 0 4%～ 0 8%异氟醚 ,或静脉泵注异丙酚 75～ 2 0 0 μg·kg 1 ·min 1 。T1 恢复至 5 %时静脉泵注莱库溴铵 3mg kg 1 h 1 ,调节泵速维持 90 %阻滞 ,持续泵注 45～ 6 0min。结果 4个麻醉组间年龄、身高、体重、莱库溴铵的单次静注用量、静脉输注总量、输注速率、输注时间、结束莱库溴铵输注后T1 恢复至 2 5 %、5 0 %、75 %和 90 %的时间、T4 T1 恢复至 70 %和 80 %的时间及肌松恢复指数 ,均无差异 (P >0 0 5 )。在结束莱库溴铵输注后T1 恢复至 90 %的时间是 34～ 5 7min ,肌松恢复指数为 2 4～ 2 9min。未见与组胺释放相关的临床指征。结论 在地氟醚、七氟醚、异氟醚和异丙酚麻醉下莱库溴铵能提供安全有效的肌松作用 ,但输注45～ 6 0min后莱库溴铵的肌松作用从短效变成中效。

Objective To evaluate the neuromuscular effects of rapacuronium(ORG 9487) under inhalation or intravenous anesthesia Methods Eighty adult patients,ASA class Ⅰ Ⅲ, sheduled for elective surgery with an anticipated duration of over 2 h ,following the anesthesia being induced with intravenous propofol 1 5 3 mg/kg and fentanyl 1 2 μg/kg and rapacuronium 1 5mg/kg, were randomly allocated to receiving inhalation of desflurane 2% 4% , sevoflurane 0 75% 1 5% or isoflurane 0 4% 0 8%,or intravenous infusion of propofol 75 200μg·kg 1 ·min 1 for anesthesia maintenance After T 1 returned to 5%, rapacuronium was intravenously infused at 3 mg kg 1 h 1 ,then adjusted to maintain T 1 at 10% of baseline ,with the rapacuronium infusion lasting 45 60 min Neuromuscular blockade was assessed with TOF GUARD accelerometer Results There was no significant differences among four groups in age,height,weight,bolus dosage of rapacuronium,total dosage of rapacuronium, rate of infusion, durations of T 1 recoving to 25%(recovery index), 50%, 75% and 90% of baseline, and of T 4/T 1 ratio recoving to 70% and 80% after the infusion withdrawal(P>0 05) The duration of T 1 recoving to 90% of baseline was 34 57min,and the recovery index was 24 29 min No any histamine related side effects were observed in all patients Conclusions Intravenous infusion of rapacuronium can produce safe and effective neuromuscular blockasde during desflurane, sevoflurane, isoflurane, or propofol anesthesia After the rapacuronium infusion of 45 60 min, the recovery from the neuromuscular blockasde is prolonged