短小全麻手术中米库氯铵与罗库溴铵肌松效应的比较

Comparison of mivacurium and rocuronium neuromuscular effects in short general anesthesia operation

目的评价短小全麻手术中米库氯铵和罗库溴铵的肌松效果及安全性。方法 60例择期行短小手术的患者随机分成两组,每组30例。两组全麻诱导均予依次静脉注射咪达唑仑0.04 mg·kg-1、芬太尼3μg·kg-1、依托咪酯0.3 mg·kg-1,在此基础上米库氯铵组予米库氯铵0.20 mg·kg-1,罗库溴铵组予罗库溴铵0.75 mg·kg-1。采用4个成串刺激(TOF)监测肌松,观察记录两组插管时情况,肌松时效指标及不良反应的发生情况,检测注药前、注药后3 min及插管后5 min血组胺浓度。结果罗库溴铵组患者气管插管条件优于米库氯铵组(P<0.05)。米库氯铵组肌松起效时间长于罗库溴铵组,而临床作用时间、恢复指数和完全恢复时间短于罗库溴铵组(P<0.05)。注药前和插管后5 min,两组血组胺浓度无显著差异(P>0.05),注药后3 min米库氯铵组血组胺浓度高于罗库溴铵组(P<0.05)。米库氯铵组内患者出现皮肤潮红18例、心动过速15例、低血压10例,罗库溴铵组分别为1例、3例、1例,组间差异显著(P<0.05)。两组均无严重不良反应发生。结论与罗库溴铵比较,米库氯铵用于全麻时虽然起效慢、也可引起短时间的组胺释放,但肌松恢复迅速,较适宜在短小手术中应用。

AIM To compare muscle relaxant effects and safety of the rocuronium and mivacurium in short surgery under general anesthesia. METHODS Sixty patients undergoing short surgery patients were randomly divided into 2 groups, mivacurium group （group M） and rocuronium group （group R）, 30 patients in each group. The patients in the two groups were injected midazolam 0.04 mg·kg^-1, fentanyl 3 μg·kg^-1, etomidate 0.3 mg·kg^-1 intravenous. The muscle relaxant drugs were applied with mivacurium 0.20 mg ·kg^-1 （group M） and rocuronium 0.75 mg·kg^-1 （group R） respectively during induction of general anesthesia. The train of four stimulation （TOF） was used to monitor the degree of neuromusclar blockade. The patients＇ tracheal intubation conditions and the onset time, the clinical effect, the recovery index and complete recovery time of muscle relaxant were observed and recorded. The blood histamine concentration before muscle relaxants injection, 3 min after injection and 5 min after the tracheal catheter inserted were measured. The adverse reactions during general anesthesia were also observed. RESULTS Compared with the group M, the endotracheal intubation conditions were better in the group R. The onset time of the group R was significantly shorter than that of the group M （P 〈 0.05）. The clinical duration of action, recovery index and the complete recovery time of the group M were significantly shorter than those of the group R （P 〈 0.05）. The patient＇ s blood histamine showed no difference between the two groups before the injection of muscle relaxants and 5 min after the tracheal catheter inserted （P 〉 0.05）. The patient＇ s blood histamine in the group M was significantly higher than that in the group R 3 min after injectied muscle relaxants （P 〈 0.05）. There were 18 patients appeared chest or neck skin flushing, 15 patients had transient tachycardia, 10 patients had transient hypotension in the group M. While there were 1 patient appeared skin flushing, 3 patients had transient tachycardia and 1 patient had transient hypotension in the group R. CONCLUSION Compared with rocuronium, the onset of mivacurium is slow and may cause transient histamine release, but it＇ s muscle relaxant recovered rapidly, then it is more suitable for short surgery under general anesthesia.