近日节律对顺式阿曲库铵肌松作用的影响

Effects of Circadian Rhythm on the Neuromuscular Blocking Effect of Cisatracurium Besilate

目的探讨近日节律对顺式阿曲库铵肌松作用起效时间、无反应期和持续时间的影响。方法择期全麻患者60例,年龄18~65岁,ASAⅠ或Ⅱ级,BMI:女18~25kg·m^(-2),男18~27kg·m^(-2)。麻醉诱导:依次静注芬太尼、咪达唑仑和依托咪酯,患者意识消失后,10s内推注顺式阿曲库铵0.15mg·kg^(-1),TOF监测拇内收肌的神经肌肉阻滞程度。根据麻醉实施的时间,分为3组:Ⅰ组08:00~11:00,Ⅱ组11:00~14:00,Ⅲ组14:00~17:00。记录顺式阿曲库铵肌松作用起效时间、无反应期和持续时间。结果 53例患者至少成功完成本试验一种观察指标的监测。顺式阿曲库铵肌松作用起效时间和无反应期3组之间比较差异无统计学意义,但持续时间在11:00~14:00时段最短,差异有统计学意义(P<0.05)。结论近日节律显著影响顺式阿曲库铵肌松作用持续时间,但对起效时间和无反应期影响无明显影响。

Objective To investigate the influence of circadian rhythm on the onset time ,clinical duration of action and no reaction period of neuromuscular blockade elicited by cisatracurium besilate .Methods Sixty patients ASA I or II,aged 18 to 65 years with body mass index of 18 to 25kg· m-2 in femal and 18 to 27kg· m-2 in male scheduled for surgery undergoing general anesthesia were enrolled .All patients received fentanyl ,midazolam,etomidate in turn for anesthetic induction.After loss of eyelash reflex,they received a bolus dose of cisatracurium of 0.15mg· kg -1 within 10 seconds .Neuromuscular blockade was assessed by tactile response of the adductor pollicis brevis muscle to TOF stimula -tion.Anesthesia were performed at three time periods：group Ⅰ（8：00-11：00）,group Ⅱ（11：00-14：00） and groupⅢ（14：00-17：00）.The onset time,no reaction period and clinical duration were record .Results Fifty-three cases at least completed one of the study .The minimum duration of neuromuscular blockade in group Ⅱwas significantly shorter than those in other groups （P〈0.05）,but there were no significant different in the onset time and no reaction period a-mong three groups.Conclusion The circadian rhythm can influence the clinical duration of action ,but not the onset time and no reaction period of neuromuscular blockade elicited by cisatracurium besilate .