罗库溴铵和顺式阿曲库铵用于肝部分切除术肌松效应的比较

Comparison of neuromuscular blockade effect of rocuronium with cisatracurium in patients undergoing partial hepatectomy

目的比较罗库溴铵和顺式阿曲库铵用于肝部分切除术的肌松效应。方法择期全麻下行剖腹单纯肝部分切除术患者40例,随机均分为罗库溴铵组(R组)和顺式阿曲库铵组(C组)。全麻肌松药诱导量R组和C组分别为2倍ED95的罗库溴铵0.6mg/kg及顺式阿曲库铵0.1mg/kg,采用TOF监测肌松程度,当TOFr至25%时追加肌松药。观察两组肌松药起效时间、气管插管条件、临床作用时间、术毕恢复指数、气管拔管时间及不良反应。结果 R组起效时间明显快于、临床作用时间及术毕恢复指数明显长于C组(P<0.05);两组气管拔管时间差异无统计学意义。当TOFr为0时,R组气管插管条件为优的例数明显多于C组(P<0.05)。R组静脉注射痛发生率为16例(80%),明显高于C组的3例(15%)(P<0.05)。两组患者围术期均未发生皮肤潮红、BP降低、HR增快及支气管痉挛等不良反应,未观察到拔管后的肌松残余作用。结论与顺式阿曲库铵比较,应用罗库溴铵具有起效快,作用时间长,虽恢复指数略长,但对拔管时间并无影响,同时未有明显的肌松残余作用,可以安全用于肝部分切除术的患者。

Objective To observe comparison of neuromuscular blockade effect of rocuronium with eisatracurium in patients undergoing partial hepatectomy. Methods Forty ASA status Ⅰ -Ⅲ patients scheduled for partial hepatectomy were enrolled in the study. Patients were randomly assigned to two treatment groups （n=20）. Group R received rocuronium 0. 6 mg/kg and group C received cisatracurium 0. 1 mg/kg as induction dose. Neuromuscular blockade was evaluated with train-of-four （TOF） stimuli of the ulnar nerve. Additional dose （0. 1 mg/kg or 0.03 mg/kg） were administered to keep the TOF rate （TOFr） at 0 to 0. 25. The time of depression, duration of action, and recovery index time were recorded. Results Time of onset was significantly shorter in patients receiving rocuronium than eisatracurium （P〈0. 05）. The duration of the effect in the group R was significantly longer than group C（P〈0. 05）. Mean time of recovery was significantly longer for patients receiving rocuronium than receiving cisatraeurium （P〈0.05）. The percentages of patients with excellent intu bation condition in group R was significantly in higher than group C （P〈0.05）. The time of extubation and adverse events in patients receiving rocuronium were similar as those treated by eisatracuriurn, Conclusion Compared with cisatracurium, rocuronium administered can rapidly and effectively achieve onset with longer, duration of action, no prolong the time to extubation although the recovery index slightly longer in the patients who has normal hepatic function undergoing partial hepatectomy.