新斯的明早期拮抗维库溴胺的可行性研究

Feasibility of early reversal of vecuronium with neostigmine in patients with elective surgery

目的 :探讨新斯的明早期拮抗维库溴胺的可行性。方法 :选择ASAⅠ～Ⅱ级 ,拟在全麻下行择期手术病人 48例 ,随机分成维库溴胺组 1 6例 ,维库溴胺 +新斯的明组 3 2例 ,后者又按在维库溴胺使用后不同时间内使用新斯的明分为Ⅰ、Ⅱ两组 ,1 0min内为Ⅰ (n=1 6例 ) ,在 1 1～3 0min内为Ⅱ (n =1 6例 )。麻醉开始后全部病人单次给予维库溴胺1 .5mg·kg-1,当手术结束时维库溴胺组静脉注入生理盐水 8ml,维库溴胺 +新斯的明组注入新斯的明0 .0 5mg·kg-1+阿托品 0 .0 2mg·kg-1+生理盐水至8ml。观察、记录各组病人从注入维库溴胺至肌张力恢复到四个成串刺激 (TOF) 0 .2 5、0 .70的时间。结果 :各组病人肌张力恢复至TOF 0 .2 5、0 .70时间为维库溴胺组 (4 5 .5 8± 8.88)min、(67.5 9±5 .60 )min。维库溴胺 +新斯的明组Ⅰ (2 3 .45±2 .82 )min、(3 1 .86± 3 .3 6)min。维库溴胺 +新斯的明组Ⅱ (2 8.70± 4.1 3 )min、(3 8.86± 2 .1 0 )min。维库溴胺 +新斯的明组恢复时间明显短于维库溴胺组(P <0 .0 1 ) ,维库溴胺 +新斯的明组Ⅰ恢复时间又明显短于维库溴胺 +新斯的明组Ⅱ (P <0 .0 1 )。手术后进行连续监测未发现再次阻滞现象。结论 :新斯的明可以早期拮抗维库溴胺的肌松效应 ,同时也提示拮抗时间愈早 。

AIM: To investigate the feasibility of early reversal of vecuronium with neostigmine. METHODS: 48 patients (ASA class I or II) scheduled for elective surgery undergoing general anaethesia were randomly assigned to vecuronium group (n=16) and vecuronium+ neostigmine group (n=32). Furthermore, the latter was divided into two groups according to the time of reversal. In vecuronium+ neostigmine group 1, the patients received neostigmine antagonization within 10 min after vecuronium administration,and in vecuronium+neostigmine group 2, time of reversal within 11-30 min after vecuronium administration. All patients received vecuronium 1.5 mg·kg -1 after general anesthesia. Neostigmine 0.05 mg·kg -1 +atropine 0.5 - 1.0 mg+saline 8 ml was administered to vecuronium+ neostigmine group and recovery was compared with that of vecuronium patients who received 8 ml saline. The time from vecuronium administration to recovery of?TOF? 0.25 ?and? 0.7 ?was recorded.?RESULTS: In vecuronium group, the recovery time to TOF 0.25 and 0.7 was ( 45.58 ± 8.88 ) min, and ( 67.59 ± 5.60 ) min, respectirely; in vecuronium+ neostigmine group 1,it was ( 23.45 ± 2.82 ) min, and ( 31.86 ± 3.36 ) min, respectirely; and in vecuronium+neostigmine group 2, it was ( 28.70 ± 4.13 ) min,and ( 38.86 ± 2.10 ) min, respectirely. The recovery time in vecuronium+neostigmine group was evidently shorter than that in vecuronium group (P< 0.01 ) and similarly the recovery in vecuronium+neostigmine group 1 was more rapid than that in vecuronium+neostigmine group 2 (P< 0.01 ). The recovery was monitored continuously after surgery, and residual neuromuscular blocking was not founded from all 48 patients. CONCLUSION: Recovery of vecuronium neuromuscular block can be antagonized by early neostigmine administration, and more early reversal, more rapid recovery.