果糖对全麻患者顺苯磺阿曲库铵肌松效果的影响

Effects of Fructose Infusion on Neuromuscular Block Produced by Cis-atracurium Besylate

目的探讨果糖对全麻患者顺苯磺阿曲库铵肌松效果的影响。方法ASAI～II级、择期全麻下行体表手术患者40例，年龄18～65岁，随机分为对照组（c组）和果糖组（F组）（n=2O）。麻醉诱导前30min内F组静滴10％果糖注射液2．5ml／kg，C组静滴生理盐水2．5ml／kg。丙泊酚、芬太尼麻醉诱导后，注入2倍ED95（0．1mg／kg）顺苯磺阿曲库铵。麻醉维持：七氟烷和瑞芬太尼。肌松监测用刺激尺神经拇内收肌四个成串刺激（TOF），记录肌松起效时间和临床有效时间及麻醉诱导前、诱导后30min、60min、90min的食道温度T0、T30、T60、T90结果食道温度：二组间比较，T0差异无统计学意义，F组T60、T90明显高于C组（P〈0．05）。组内比较，与T0相比，二组T30、T60、T90均明显降低（P〈0．05）。肌松效果：二组肌松起效时间差异无统计学意义，F组临床有效时间明显短于c组（P〈0．05）。结论麻醉前输注果糖可缩短顺苯磺阿曲库铵肌松临床有效时间，但不影响其起效时间。其原因可能与果糖减缓全麻时体温下降有关。

Objective To investigate the effect of fructose infusion on neuromuscular block produced by cisatracurium besylate. Methods Forty adult patients （ASA I or II, aged 18 to 65）, scheduled for ophthalmology and otorhinolaryngology or Mammary gland resection surgery under general anesthesia were randomly assigned into 2 groups（n=20 each）： control group（group C）and fructose group（group F）. 30 minutes before induction, 10% of fructose solution was administrated in group F, at a rate of 2.5ml/kg. In group C normal saline was administrated at the same rate. After inducing with propofol and fentanyl, 0.1 mg/kg （2ED95） of cisatracurium besylate was given. Then maintained with sevoflurane and remifentanil. Neuromuscular transmission of ulnar nerve was monitored in train of-four（TOF） stimulating mode. Onset time, clinical duration and esophagus temperature before induction（T0） and 30min（T30）, 60min（T60）, 90min（T90） after induction were recorded. Results To of the two groups showed no difference. T30, T60, T90 in group F were significantly higher than group C （P〈0.05）. T30, T60, T90 were significantly decreased compared with To in the two groups （P〈0.05）. The onset time between the two groups showed no difference. The clinical duration of group F was significantly shorter than group C（P 〈0.05）. Conclusion Preoperative fructose infusion shortened clinical duration of cis-atracurium besylate, but didn＇t significantly change the onset time. The result maybe relative to the preoperative infusion of fructose which helped maintain intraoperative normothermia.