静脉应用硫酸镁对维库溴铵肌松作用的影响

Influence of intravenous magnesium sulfate on muscle relaxation effects of vecuronium

目的：探讨术中静脉应用硫酸镁对维库溴铵肌松作用的影响及其安全性。方法：60例择期行腰椎间盘髓核摘除＋内固定术的患者,随机分为两组,各30例。麻醉诱导插管后,A组静脉滴注40 mg/kg的硫酸镁,B组给予同体积的生理盐水。术中通过血浆浓度靶控输注丙泊酚（3.0-3.5μg/ml）、瑞芬太尼（3.0-4.0 ng/ml）,维持脑双频指数（bispectorial index,BIS）为45-55;设定四个成串刺激（train of four,TOF）为0,通过闭环肌松集成靶控注射系统输注维库溴铵。在术前（t1）,输注硫酸镁或安慰剂完毕后10 min（t2）、60 min（t3）,停用维库溴铵时（t4）4个时间点上,检测血清Mg2＋、Ca2＋与K＋浓度。测量在输注硫酸镁或安慰剂完毕后5 min时的心率和平均动脉压。记录使用维库溴铵的总剂量,停用维库溴铵后TOF恢复达70%的时间T70%。结果：A组血清Mg2＋浓度在t2时达到最高（1.33±0.19）mmol/L,随着手术时间的延长逐渐降低（P〈0.05）;到t3、t4时,A组血清Mg2＋浓度仍较B组高（P〈0.05）;两组患者的血清Ca2＋、K＋浓度,以及心率和平均动脉压均无显著性差异（P均〉0.05）。A组维库溴铵剂量为（3.22±0.57）μg/（kg·min）,明显少于B组（3.81±0.58）μg/（kg·min）（P=0.000 2）;A组T70%为（26.3±3.6）min,较B组（28.7±4.3）min减少（P=0.022 5）。结论：静脉应用40 mg/kg硫酸镁可增强维库溴铵的肌松作用,减少其用量,缩短肌力恢复时间,对血清Ca2＋、K＋浓度及血流动力学无显著影响。

Objective：To investigate the influence of intraoperative intravenous magnesium sulfate on muscle relaxation effects of vecuronium,and evaluate its safety.Methods：Sixty patients underwent elective lumbar discectomy and internal fixation were randomly divided into two groups with 30 cases in each group.After induction of anesthesia,40 mg/kg of magnesium sulfate was given in group A through intravenous infusion,group B received the same volume of saline.Propofol（3.0~3.5 μg/ml） and remifentanil（3.0~4.0 ng/ml） were injected by plasma concentrations target-controlled infusion to maintain BIS at 45 ~55.Vecuronium was administrated with muscle relaxants integrated closed-loop target controlled injection system,and TOF was set to 0.Serum Mg2＋,Ca2＋and K＋concentration were detected at four time points：preoperative（t1）,10 min（t2） and 60 min（t3） after medication of magnesium or placebo,and t4when vecuronium was disabled.Heart rate（HR） and mean arterial pressure（MAP） were accessed 5 min after medication of magnesium or placebo.The time of T70%（TOF recover up to 70%） and the total dosage of vecuronium were recorded.Results：Serum concentration of Mg2＋reached a maximum（1.33 ± 0.19 mmol/L） at t2,and declined gradually through the passing of operation time in group A（P 0.05）,and still higher than that in group B at t3and t4（P 0.05）.Serum concentration of Ca2＋and K＋,as well as HR and MAP showed no significant difference between the two groups（P 0.05）.The dosage of vecuronium was（3.22 ±0.57） μg/（kg·min） in group A,significantly less than that in group B（3.81 ± 0.58） μg/（kg·min）（P = 0.0002）;T70%in group A and group B were（26.3 ± 3.6） min and（28.7 ± 4.3） min,respectively,the difference was statistically significant（P = 0.0225）.Conclusion：Intravenous injection of 40 mg/kg magnesium sulfate could enhance muscle relaxation effects of vecuronium,reduce the dosage and shorten neuromuscular recovery time,and has no significant effect on serum concentration of Ca2＋,K＋and hemodynamics.