罗哌卡因硬膜外阻滞对老年及中青年患者顺式阿曲库铵肌松效应的影响

The effects of ropivacaine administered epidurally on neuromuscular blockade of cisatracurium ingeriatric and adult patients

目的观察全麻复合罗哌卡因硬膜外阻滞对老年及中青年患者顺式阿曲库铵肌松效应的影响。方法全麻复合硬膜外阻滞下行中下腹部手术的老年患者以及中青年患者各40例,分别随机均分为四组:老年患者均分为全麻复合硬膜外阻滞1组(EA_1组)、全麻1组(GA_1组),中青年患者均分为全麻复合硬膜外阻滞2组(EA_2组)和全麻2组(GA_2组)。EA_1组及EA_2组患者硬膜外分次给予0.75%罗哌卡因,GA_1组及GA_2组按相同方案给予等量生理盐水,静注依托咪酯、芬太尼及顺式阿曲库铵0.15mg/kg行全麻诱导,持续输注丙泊酚、舒芬太尼和顺式阿曲库铵维持麻醉,术中维持BIS于40～50之间及T1于10%Tc水平,观察各组患者顺式阿曲库铵肌松效应的变化。结果四组起效时间、恢复指数及TOFR自然恢复时间差异无统计学意义。EA_1组的临床肌松作用时间明显长于GA_1、EA_2和GA_2组(P<0.01或P<0.05),而GA_1、EA_2组的临床肌松作用时间明显长于GA_2组(P<0.05)。EA_1组顺式阿曲库铵的总维持用量明显低于GA_1、EA_2及GA_2组(P<0.01)。结论不论老年还是中青年患者,罗哌卡因硬膜外阻滞对顺式阿曲库铵的起效时间以及TOFR自然恢复时间无明显影响,但可延长其临床肌松作用时间,增强其肌松效应,老年患者罗哌卡因增强作用的时效延长,顺式阿曲库铵的维持用量明显减少。

Objective To observe the effects of ropivacaine administered epidurally on the neuromuscular blockade of cisatracuruim in geriatric and adult patients. Methods Forty elderly patients and forty adult patients, scheduled for elective abdominal surgery with combined general and epidural anesthesia were distributed into groups EA1, GAI and groups EA2, GA2 randomly （n=20）. A bolus of 0. 16 ml/kg of 0. 75% ropivacaine were given in EA1 and EA2 group, followed by a supplementary dose of 0. 06 ml.kg-1 .h-1. The same volume of saline was given epidurally in groups GA1 and GA2. General anesthesia was induced with etomidate and fentanyl, and maintianed with propofol and sufentanil to keep BIS between 40-50. Neuromuscular block was induced with cisatracurium 0. 15 mg/kg and monitored with TOF-Watch SX acceleromyography at the adductor pollieis. Intubation was performed when T1 was lower than 5% To. When T1 had recovered to 25%o Te, eisatracurium was infused and titrated to maintain T1 stay at 10% Te. The neuromuscular blockade of cisatraeurium in all groups were observed. Results The onset time, recover index and the time from discontinuation of cisatraeurium to TOFR spontaneous recovery to 0. 25, 0.5, 0. 7 and 0. 9 did not differ between four groups. Compared with group EA1, the clinical duration was significantly shorter in groups GA1 ,EA2, GA2 （P〈0.01 or P〈0. 05）. In group GA2, the clinical duration was shorter than both in groups GAI and EA2 （P 〈 0. 05）. The total dosage of cisatracurium was significantly lower in groups EA1 than groups GA1, EA2 and GA2 （ P 〈 0.01 ）. Conclusion Ropivaeaine administered epidurally does not influence the onset time and the spontaneous recovery time of cisatracurium while delays the clinical duration and reduces the requirement of cisatraeurium, so as to enhance the neuromuscular blockade of cisatracurium. It seems more obviously in the elderly patients.