右美托咪定不影响全凭静脉麻醉下顺阿曲库铵的肌肉松弛效应

Dexmedetomidine pre-infusion has no influence on muscle relaxation effect of cisatracurium under total intravenous anesthesia

目的观察右美托咪定对全凭静脉麻醉下顺阿曲库铵肌肉松弛效应的影响。方法选取60例美国麻醉医师协会分级Ⅰ或Ⅱ级并在全身麻醉下行胸腔镜手术的患者，将其随机分入3组，每组20例，分别在麻醉诱导前15min于10min内经静脉泵注射右美托咪定0．6μg／kg（Dex0．6组）、右美托咪定1．0μg／kg（Dex1．0组）、0．9％氯化钠溶液（对照组）。3组均采用丙泊酚和舒芬太尼行麻醉诱导，在肌肉松弛定标完成后予顺阿曲库铵0．1mg／kg。采用加速度法4个成串刺激监测肌肉松弛情况，第1次颤搐反应（T1）消失后插入双腔气管导管，维持脑电双频指数值为40～60，呼气末二氧化碳分压为30-40mmHg（1mmHg=0．133kPa），鼻咽温度〉36℃，肌肉松弛监测部位皮温〉32℃。观察终点为T1恢复至基础值的75％。记录顺阿曲库铵的起效时间、临床作用时间和恢复指数；在给试验药前（Tc）、给试验药后（T1）、气管内插管后即刻（T2），以及气管内插管后1（T3）、5（T4）、30min（T5）各时间点，记录患者的平均动脉压（MAP）、心率（HR）；记录观察期间的丙泊酚用量。结果3组患者的肌肉松弛起效时间、临床作用时间、恢复指数和各时间点MAP的差异均无统计学意义（P值均〉0．05），Dex0．6组、Dex1．0组在T1至T4时间点的HR均显著慢于对照组同时间点（P值均〈0．05），Dex0．6组和Dex1．0组的丙泊酚用量均显著少于对照组（P值均〈0．01）。结论麻醉前预先注射右美托咪定不影响顺阿曲库铵的起效时间、临床作用时间和恢复指数。

Objective To observe the influence of dexmedetomidine pre-infusion on cisatracurium muscle relaxation effect under total intravenous anesthesia. Methods In this prospective, randomized, double-blinded study, a total of 60 patients scheduled for video-assisted thoracoscopic surgery under general anesthesia were randomly assigned to three groups （n = 20）. Dexmedetomidine 0.6 μg/kg （Dex0.6 group）, dexmedetcmidine 1.0 μg/kg （Dex1. 0 group）, and 0.9% sodium chloride solution （control group） were given by venous pump 15 min before anesthesia, respectively. The anesthesia was induced by propofol and sufentanil in all patients. Cisatracurium 0. 1 mg/kg was administered after muscle relaxation. Neuromuscular function was monitored by acceleromyography. The double-lumen endotracheal tube was inserted when the first twitch response （T1） disappeared. The bispectral index value （BIS） maintained between 40 and 60, end-tidal carbon dioxide partial pressure was 30-40 mmHg （1 mmHg = 0. 133 kPa）, nasopharyngeal temperature〉 36 ℃, and skin temperature of muscle relaxation monitoring site 〉32 ℃. When T1 reached 75% of the base value, the observation ended. The onset time, clinical duration of action and recovery index of cisatracurium were recorded. The mean arterial pressure （MAP）, heart rate （HR） at the following time points： before administering the test drug （T0）, after administering the test drug （T1）, after endotracheal intubation （T2）, 1 min after intubation （T3）, 5 min after intubation （T4）, and 30 min after intubation （T5） were also recorded. The consumption of propofol during observation was measured. Results There were no significant differences in terms of the onset time, clinical duration of action, recovery index of cisatracurium, or MAP at each time point between groups （all P〉0.05）. The HR of Dex0.6 group and Dex1. 0 group in T1, T2, T3 and T4 were significantly slower than thoset of the control group （all P〈0.05）. Compared with that in the control group, the consumption of propofol in Dex0.6 group and Dex1. 0 group were significantly decreased （both P 〈 0. 01 ）. Conclusion Dexmedetomidine infusion before anesthesia will not affect the onset time, clinical duration of action or recovery index of cisatracurium.