七氟烷对国产顺式阿曲库铵神经肌肉深度阻滞期的影响

Effect of Sevoflurane on Deep Neuromuscular Blockade Induced by Homebred Cisatracurium

目的观察七氟烷吸入麻醉与丙泊酚静脉麻醉两种不同麻醉维持方法下对国产顺式阿曲库铵神经肌肉深度阻滞期的影响。方法择期行全身麻醉下胆囊切除手术患者60例，ASAI～Ⅱ级，麻醉诱导插管后随机分为S组（n=30）和V组（n=30），分别采用成七氟烷＋瑞芬太尼和丙泊酚＋瑞芬太尼维持麻醉。使用连续肌松监测仪连续测定左手拇内收肌的四个成串刺激（TOF）值，无反应期进行强直刺激后单次刺激肌颤搐计数（PTC）；记录阻滞起效时间、深度阻滞维持时间、深阻滞恢复时间、25％TOF恢复时间、95％TOF恢复时间，计算出深-浅交界阻滞时间及总体内作用时间。结果两组深度阻滞期时间比较无统计学差异（P〉0．05），但S组深-浅交界阻滞时间及25％TOF恢复时间明显长于V组（P〈0．05）。结论七氟烷加强国产顺式阿曲库铵肌松时间位于PTC首次出现到TOF 25％恢复的深-浅阻滞交界时间段，部位主要在接头后膜。

Objective To compare the effects of inhalation anesthesia of sevoflurane and intravenous an- esthesia of propofol on deep neuromuscular blockade induced by homebred cisatracurium. Methods 60 patients, ASA I to Ⅱ, undergoing cholecystectomy were randomly divided into 2 groups, with 30 cases for each. After eisatracurium administration, maintenance of anesthesia was performed by sevoflurane plus remifentanil in group S and propofol plus remifentanil in group V. Train-of-four ratio （TOF） was monitored to assess the neuromuscular block by a muscle relaxation monitor. In no reaction period, post titanic count （PTC） was recorded after tetanic stimulation. Block work time, maintain time of deep blockade, recovery time of deep blockade, recovery time of 25% TOF and recovery time of 95% TOF were recorded. The time of deep-shallow adjacent blockade and the overall effect time were calculated. Results There was no difference in time of deep blockade between two groups（ P 〉 0.05 ）. The time of deep-shallow adjacent blockade and recovery time of 25% TOF in group S were signifieandy longer than those in V group, there was statistic difference between two groups （ P 〈 0.05 ）. Conclusion Sevoflurane can enhance the muscle relaxation of eisatracurium, with the action time in the period between first PTC to deep-shallow adjacent blockade after recovery time of 25% TOF and the site in postjunctional membrane.