递减法持续输注顺式阿曲库铵的药效动力学研究

Study on the Pharmacodynamics of Cisatracurium by Decreasing Continuous Infusion

目的通过递减法持续输注顺式阿曲库铵与间断给药两种方式的药效学比较，探讨其最佳给药方式。方法ASAI-Ⅱ级，拟行择期脊柱手术患者40例，随机分两组，递减法持续输注组（I组）、间断输注组（Ⅱ组）。应用TOF刺激方式，监测拇指内收肌颤搐的变化。记录两组神经肌肉阻滞程度、总用药量，计算平均输注速度：记录Tl恢复至25％、75％的时间以及恢复指数（RI）。使用静脉麻醉诱导，七氟醚吸入麻醉维持。神经肌肉阻滞的监测直至TOF（T4／T1）≥75％，患者自主呼吸恢复后拔去气管导管。结果I组平均输注速度明显慢于Ⅱ组（P〈0．05），T1恢复至25％、75％的时间I组明显快于Ⅱ组（P〈O．05）。两组恢复指数比较差异无统计学意义（P〉0．05）。结论与间断给药相比，递减法持续输注能够减少术中顺式阿曲库铵的用量．获得更稳定的神经肌肉阻滞效果，且停药后恢复快。

Objective The study is designed to compare the pharmacodynamics of cisatracurium by decreasing continuous infusion and intermittent bolus injection so as to find the best way of administration. Methods 40 ASA I-Ⅱ patients undergoing elective spinal surgery were randomly divided into 2 groups. Patients in group I received eisatraeurium by decreasing continuous infusion and in group Ⅱ by intermittent bolus injection. The responses of adductor pollicis were monitored by train-of-four （TOF） stimulation.The level of neuromuscular blockade and the total dose of cisatracurium were recorded, the average infusion rate was calculated; the recovery time of T1 to 25% and 75%, and recovery index （RI） of the two groups were recorded. Intravenous anesthesia was used for both induction, and maintained,by sevoflurane inhalation. Neuromuscular blockade was monitored until TOF ratio （T4/T1） ≥75%. The patients were extubated when spontaneous breath recovered. Results The average infusion rate was significantly slower in group I than that in group Ⅱ（P〈0.05）; the recovery time of T1 to 25% and 75% was significantly faster in group I than that in group Ⅱ （P〈O.05）; There were no significant differences in the recovery index in both groups （P〉0.05）. Conclusion Decreasing continuous infusion of cisatracurium can reduce the dose of cisatracurium used in the surgery and obtain a more stable neuromuscular blockade, and the spontaneous recovery from neuromuscular block is faster than that by intermittent bolus injection.