麻黄碱复合预注法对老年患者顺苯磺酸阿曲库铵起效时间和血流动力学的影响

Effects of ephedrine pretreatment and cisatracurium priming on the cisatracurium-induced neuromuscular blockade and hemodynamics in elderly patients

目的比较麻黄碱预处理，小剂量顺苯磺酸阿曲库铵预注以及二者联用对老年患者顺苯磺酸阿曲库铵起效时间和血流动力学的影响。方法气管内插管全身麻醉下手术的老年患者60例，应用随机数字表法分为4组：麻黄碱组（E组）、小剂量顺苯磺酸阿曲库铵预注组（P组）、麻黄碱预处理复合小剂量顺苯磺酸阿曲库铵预注组（PE组）、对照组（C组），每组各15例。P组和PE组静脉注射顺苯磺酸阿曲库铵0．015mg／kg。E组和PE组静脉注射麻黄碱70μg/kg。靶控输注异丙酚，静脉注射芬太尼诱导。随后E组和C组静脉注射顺苯磺酸阿曲库铵插管剂量0．15mg／kg，P组和PE组静脉注射剩余插管剂量。待肌颤搐反应消失后行气管插管。结果PE、C、E、P组起效时间[（164±28）s、（306±61）s、（187±31）s、（193±40）s比较差异有统计学意义，F=33．990，P〈0．01]，PE组的起效时间明显短于C组、E组和P组且差异均有统计学意义（P〈0．01，P〈0．05）。诱导后各组收缩压（SBP）（F组内=35．783，P=0．000）、平均动脉压（MAP）（F自自=30．015，P=0．000）与同组诱导前比较均显著下降；PE组的SBP、舒张压（DBP）、MAP均显著高于C组（P均〈0．05）；E组的SBP、DBP、MAP也显著高于C组（P均〈0．05）；诱导后PE组和C组的心率（HR）比较差异有有统计学意义（P〈0．05），C组HR较诱导前显著下降（P〈0．05）。诱导后血压降低C组有11例，P组有10例，而E组和PE组各有5例和4例，差异有统计学意义（χ^2=9．867，P〈0．05）。插管后血压升高E组有5例，PE组和P组各有4例，C组有3例，差异无统计学意义（χ^2=0．682，P〉0．05）。结论70μg／kg的麻黄碱可缓解老年患者异丙酚诱导时的循环抑制，复合小剂量顺苯磺酸阿曲库铵预注可进一步缩短其起效时间，适合于老年人。

Objective To compare the effects of Ephedrine and combined with small dose cisatracurium treatments on the onset time of eisatracurium and hemodynamics in elderly patients. Methods Sixty cases of elderly patients undergoing elective surgery under general anesthesia were randomly divided into 4 groups： E group （ ephedrine pretreatment）, P group （ cisatracurium primin）, PE group （ cisatraeurium priming and ephedrine pretreatment ） and C group（control） ,and each group of 15 cases. Cisatracurium 0. 15 mg/kg were given in P group and PE group, and then ephedrine 70 μg/kg were given in PE group and E group. Anesthesia was induced with target controlled infusion of propofol （ target plasma concentration 3 - 5 μg/ml ）, fentanyl 3 - 4 μg/ kg. Cisatracurium 0. 015 mg/kg were given in E group and C group, and P group and PE group dose intravenous cannula remaining. Tracheal intubation was performed when the twitch height depressed to 0. Results The Onset time of PE,C,E and P group were （164±28） s, （306＋61） s, （187±31） s and （193±40） s and there were significant differences（ F= 33. 990,P〈0. 01 ）. The onset time of PE group was shorter than that in C, E, P group, and the difference was significant（ P〈0.05 ）. Systolic pressure （SBP） and mean arterial pressure （MAP） levels in four groups after induction were lower than those before induction （ F = 35. 783,30. 015, P = 0. 000 ） ± SBP, diastolic blood pressure （ DBP ）, MAP in PE group and E group were significant higher than those in C group（ P〈0. 05 ）. After inductions, heart rate （HR） in PE group was significant different form that in C group （P 〈0. 05）, and HR of C group was significantly decrease than before inductions （P〈 0.05 ）. After inductions, the cases with DBP were 11 patients （ 73.3% ） in C group, 10 patients （ 66. 7% ） in P group ：, 5 patients （33.3%） in E group, and 4 patients （ 26. 7% ） in PE group, the different were significant （χ^2 = 9. 867, P 〈 0.05 ）. After intubation, cases with increase blood press were 3 patients （20. 0% ） in C group,5 patients（ 33.3% ） in E group, and 4 patients（ 26. 7% ） in E group and PE group（P〉0.05 ）. Conclusion Ephedrine of 70 I±g/kg Can relief the circulatory depression and accelerate the onset time of cisatracurium in the elderly patients. Combined with cisatracurium priming can further shorten the onset time and be for elders.