米库氯铵静脉注射与闭环靶控输注的药效学比较

Pharmacodynamic effects of mivacurium in bolus infusion compared with in closed-loop feedback computer-controlled infusion

目的探讨单次静脉注射和长时间闭环靶控输注(TCI)对米库氯铵用量及药效学的影响。方法择期全麻手术患者24例,年龄18～65岁,ASAⅠ或Ⅱ级,随机均分为单次静脉注射组(A组)和闭环TCI组(B组)。采用TOF-WatchSX型加速度肌松监测仪刺激尺神经,观察拇内收肌颤搐情况。连续记录肌松监测值并计算给药后肌松起效时间、最大肌颤抑制程度、无反应时间、T125%恢复时间、恢复指数和用药总量,同时记录皮肤红斑等不良反应。结果两组患者不同时点BIS值、血流动力学指标和大鱼际肌皮肤温度、肌松起效时间、最大肌颤抑制程度、恢复指数、T125%恢复时间差异均无统计学意义。B组无反应时间明显长于、用药总量明显大于A组(P<0.05)。两组均未出现皮肤红斑、一过性心动过速、支气管痉挛等不良反应。术毕随访患者,无一例出现术中知晓。结论长时间输注米库氯铵未见明显药物蓄积效应,闭环TCI米库氯铵可能更利于肌松深度的调节。

Objective To investigate the pharmacodynamics effect of mivacurium during bolus injection and long term closed-loop feedback computer-controlled infusion. Methods Twenty-four ASA I or ]I adults undergoing elective surgery were randomly assigned to two groups （n= 12 each group） ：group A received initial bolus dose alone, and group B received closed-loop infusion after the initial bolus dose. Muscular relaxant extent was assessed by acceleromyography in adductor pollicis. The onset time （time from drug administration to maximum effects）, maximal depression of the twitch response, non-response time, time to recovery of T1 25~, recovery index and the dosage of mivacurium were observed. Side effects such as skin erythema were recorded. Results There were no differences in onset time, maximal depression of the twitch response, time to recovery of T1 to 25 ~, recovery index between the two groups. The dosage of mivacurium and non-response time in group B was more than that in group A （P^0. 05）. There was no evidence of skin erythema, transient tachycardia, bronchospasm or awareness during the surgery in either group. Conclusion Continuous infusion of mivacurium has no evidence of cumulative effect and the closed-loop feedback computer- controlled infusion of mivacurium has more superiority in controlling the depth of the neuromuscular blockade.