预注顺阿曲库铵与增大其剂量在全麻诱导中的效果比较

Comparison of the priming principle of cisatracurium and increasing the dose in duration of anesthesia effect

目的通过观察在全麻诱导插管中,预注顺阿曲库铵和增大其剂量两种给药方式对其起效时间、临床有效时间及肌松效果的影响,并进行对比,指导此药的临床应用。方法选择18~55岁,ASAⅠ~Ⅱ级择期行妇科手术的女性患者90例,随机分为3组,每组30例,分别为3ED95组、预注组（预注顺阿曲库铵0.015 mg/kg,4 min后给予0.135 mg/kg）和4ED95组。麻醉诱导使用芬太尼、咪达唑仑、丙泊酚,麻醉维持应用靶控微量泵输注丙泊酚、瑞芬太尼,TOF模式监测肌松情况。记录血压、心率及全身皮肤情况,记录肌松药起效时间、临床有效时间及气管插管条件评级。结果各组麻醉诱导期间血流动力学的变化比较均无统计学意义,各组肌松药起效时间分别是（184±56）s、（141±31）s、（135±45）s,预注组、4ED95组分别与3ED95组之间的比较均有统计学意义（P〈0.05）,但4ED95与预注组相比较无统计学意义（P〉0.05）;各组临床有效时间分别是（41±8）min、（44±6）min、（53±8）min,4ED95组分别与3ED95组、预注组相比较均有统计学意义（P〈0.05）,预注组与3ED95组比较无统计学意义（P〉0.05）。结论预注顺阿曲库铵与增大其剂量均能加快药物的起效时间,但前者比后者维持的临床有效时间更短,更有利于患者的苏醒及快速拔管。

Objective To study the effects of the priming principle of cisatracurium and increasing the dose on the onset time and the clinical duration. Methods 90 patients ASA I-Ⅱ, aged 18-55 years, scheduled for elective gynecologic surgery were randomly allocated to three groups with 30 cases each. Group I received cisatracurium 0.15 mg/kg （3ED95）. Group Ⅱ received cisatracurium 0.015 mg/kg four minutes before induction and then cisatracurium 0.135 mg/kg. Group Ⅲ received cisatracurium 0.2 mg/kg（4ED95）. Neuromuscular block was monitored by a TOF Watch SX accelerograph. The onset time and the clinical duration were recorded.Results The onset times for group I, Ⅱand Ⅲwere （184±56） s, （141±31） s, （135±45） s seconds respectively. Compared with group I, there was significant difference in group Ⅱ, Ⅲ respectively （P〈0.05）; the clinical effective time were （41±8） min, （44±6） min, （53±8） min respectively. Compared with that of group III, there was a remarkable difference in group I and group II （P〈0.05）. Conclusion The priming principle can significantly shorten cisatracurium onset time of intubation. Compared with increasing the dose, its clinical duration is shorter.