不同剂量硫酸镁预处理对顺式阿曲库铵肌松效应的影响

Influence of different dosage of magnesium sulfate pretreatment on onset and recovery characteristics of cisatracurium

目的评价不同剂量硫酸镁(MgSO4)预处理对顺式阿曲库胺(Cis)肌松效应的影响。方法全组75例ASAⅠ或Ⅱ级患者,随机分为硫酸镁1组(MgSO4 1组)、硫酸镁2组(MgSO4 2组)和对照组(C组)。在丙泊酚、芬太尼和Cis 0.15 mg/kg麻醉诱导前,MgSO4 1组和MgSO4 2组分别静脉注射MgSO4 30 mg/kg和40 mg/kg(0.9%氯化钠稀释成100 ml,≥10 min慢注完毕),C组给予0.9%氯化钠100 ml。麻醉维持是丙泊酚、瑞芬太尼。采用四个成串刺激监测肌松起效时间、临床肌松持续时间、恢复指数和完全恢复时间以及平均动脉压(MAP)、心率(HR)和血浆镁离子浓度等。结果 MgSO4两组起效时间明显短于C组[(2.8±0.8)min和(2.6±0.9)min vs.(3.5±0.7)min,P<0.01],临床持续时间和恢复指数三组无统计学差异(P>0.05),完全恢复时间MgSO4 2组明显长于C组[(67.9±8.7)min vs.(61.4±9.5)min,P<0.05]。与给MgSO4前比,MgSO4两组MAP在给予MgSO4后显著降低,而HR显著增快(均P<0.05)。MgSO4两组在给予MgSO4后各时间点血中镁离子浓度明显增高(P<0.01),但均在正常值范围。结论 MgSO4预处理可缩短Cis(0.15 mg/kg)肌松起效时间,随着MgSO4的剂量增加,恢复时间可能延长;有利于改善气管插管条件,是妊高征或先兆子痫剖宫产患者全麻诱导时一种选择。

Objective To evaluate the effectiveness of different dosage of magnesium sulfate pretreatment on onset and recovery characteristics of cisatracurium. Methods A total of 75 ASAⅠ-Ⅱ patients were randomly allocated to three groups. The group MgSO41（n=25）, 30 mg/kg in 0.9%normal saline （total volume 100 ml）, the group MgSO4 2 （n=25）, 40 mg/kg in 0.9% normal saline, and the control group （0.9% normal saline, n=25）. Before induction of general anesthesia with propofol, fentanil and cisatracurium 0.15 mg/kg, patients in magnesium group received MgSO4 30 mg/kg or MgSO4 40 mg/kg in saline alone intravenously for 10 minutes, and patients in control group received the same volume of saline without MgSO4. Anesthesia was maintained with propofol and remifentanil. Electromyographical responses were measured by train-of-four. onset time, clinical duration, recovery index, and total recovery time were measured. The mean arterial blood pressure（MAP）, heart rate（HR）, and ionized magnesium were also measured. Results The onset time were significantly shorter in the both MgSO4 groups than the control group （P〈0.01）. Clinical duration and recovery index showed no significant differences in the both MgSO4 groups compared to the control group （P＆gt;0.05）.Total recovery time were significantly prolonged in the MgSO4 2 group than the control group （P〈0.05）. MAP was more significantly decreased in the both MgSO4 groups after the administration of MgSO4, and HR was more significantly increased. The concentrations of ionized magnesium were significantly more increased at the all time point in the both MgSO4 groups （P〈0.01）. Conclusions MgSO4 pretreatment shortening of onset time of cisatracurium （0.15 mg/kg）, prolongation on the recovery of neuromuscular block with increase of the dose of magnesium sulfate, and improved clinical intubating conditions.