顺式阿曲库铵两种不同给药方式对肌松残余作用的影响

Comparison of the residual neuromuscular blockade caused by the different administration ways of cisatracurium

目的比较顺式阿曲库铵持续输注与间断给药对肌松残余作用的影响。方法择期行腰椎管狭窄或胸腰椎体骨折手术患者80例,年龄18～70岁,随机分为A1、A2、B1和B2四组,每组20例。A1和A2组分别微量泵持续输注顺式阿曲库铵1.5和0.75μg·kg-1·min-1,B1和B2组分别静脉间断注射顺式阿曲库铵0.1和0.05mg·kg-1·h-1。A1组与B1组、A2组与B2组肌松药使用总量相同。记录肌松药使用总量,TOFr达25%、50%、75%、90%的时间,拔管时间,患者能够持续抬头5s的时间。结果与A2组比较,A1组TOFr恢复至25%、50%时间明显延长(P<0.05);与B1组比药,A1组TOFr恢复至25%的时间明显延长(P<0.05);与B2组比较,A2组TOFr恢复至50%、75%时间明显延长(P<0.05);B1组TOFr恢复至50%、75%、90%时间明显延长(P<0.05)。与A2组比较,A1组患者肌力恢复于Ⅳ～Ⅴ级的时间及能够持续抬头5s的时间明显延长(P<0.05)。结论顺式阿曲库铵持续输注与间断给药对肌松残余作用均无明显影响,但持续输注可延长肌松恢复时间。

Objective To observe the residual neuromuscular blockade caused by different administration ways of cisatracurium （continuous infusion and intermittent bolus injection）. Methods Eighty ASA I or lI patients,aged from 18 to 70,undergoing selective spinal surgery with general anesthesia, were equally randomized into four groups（n = 20）. Patients received cisatracurium by continuous infusion with 1.5 μg·kg^-1·min^-1 in group A1 and 0. 75μg·kg^-1·min^-1 in group A2, patients received intermittent bolus injection with 0. 1 mg· kg ^-1 · h^-1 in group B1 and 0.05 mg· kg ^-1 · h^-1 in group B2. The cisatracurium consumption and TOFr recovered to 25 %, 50%,75%, 90%, extubation time, continuing look up 5 s time, tidal volume and respiratory rate before and after anesthesia were recorded.Results Compared with group A2,time of TOFr recovery to 25%, 50% in gourp A1 were significantly increased（P〈20.05）. Compared with group B1, time of TOFr recovery to 25% in group A1 was significantly increased （P 〈0.05）. Compared with group B2, time of TOFr recovery to 50 %, 75 % in group A2 were significantly increased（P〈0.05） . time of TOFr recovery to 50 %, 75%, 90% in group B1 were significantly increased（P 〈0.05）. Compared with group A2, time of muscle strength recovery to IV-V and continuing look up 5s were significantly increased（P〈 0.05）. Conclusion Cisatracurium continuous infusion and intermittent bolus injection have no influence on the residual effect of muscle relaxant, but continuous infusion may effect on the time of muscle relaxant.