右美托咪定预处理对琥珀胆碱引起的肌纤维成束收缩和肌痛的影响

Effects of dexmedetomidine pretreatment on succinylcholine-induced muscle fasciculations and myalgia

目的：观察右美托咪定预处理对琥珀胆碱引起的肌纤维成束收缩和肌痛的影响。方法选择84例择期采用静吸复合麻醉在显微喉镜下行声带手术的患者，年龄25～65岁，美国麻醉医师协会分级Ⅰ或Ⅱ级，随机分入右美组和对照组，每组42例。2组患者均静脉注射芬太尼2μg／kg、异丙酚2 mg／kg、琥珀胆碱1．5 mg／kg行麻醉诱导，右美组在诱导前10 min经静脉输注泵注射右美托咪定0．5μg／kg，气管插管后2组均吸入七氟烷和静脉间断注射异泊酚、琥珀胆碱10～20 mg维持麻醉。观察注射琥珀胆碱后的肌纤维成束收缩程度，记录琥珀胆碱的用量。术后24 h随访患者的肌痛发生情况。结果右美组的肌纤维成束收缩发生率为95％（40／42），对照组为95％（40／42），2组间的差异无统计学意义（P＞0．05），2组间严重程度的差异无统计学意义（P＞0．05）；患者的肌纤维成束收缩与术后肌痛无关联（P＞0．05）；右美组术后肌痛发生率（42．9％）有低于对照组（50％）的趋势，但2组间的差异无统计学意义（P＞0．05）；右美组的琥珀胆碱用量显著低于对照组（P＜0．01）。结论右美托咪定不能减轻琥珀胆碱所引起的肌纤维成束收缩，对术后肌痛发生率和严重程度无显著影响，但右美托咪定能减少琥珀胆碱的用量。

Objective To observe the effects of dexmedetomidine pretreatment on succinylcholine -induced muscle fasciculations and myalgia .Methods A total of ASAⅠ/Ⅱ84 patients aging 25 to 65 were included into the current study . These patients were scheduled for vocal cord surgery through laryngoscopy under combined intravenous and inhalation an -esthesia.They were randomly divided into a dexmedetomidine group and a control group （n=42）.Anesthesia induction was conducted in each group using 2 μg/kg fentanyl, 2 mg/kg propofol and 1.5 mg/kg succinylcholine.Patients in the dexmedetomidine group were pretreated with 0.5μg/kg dexmedetomidine 10 min before anesthesia induction .After intu-bation, anesthesia was maintained in each group through inhalation of sevoflurane and intravenous injection of propofol and succinylcholine （10-20 mg）.Muscle fasciculation was observed .The doses of succinylcholine were recorded .The incidence of myalgia was assessed in follow -up visits 24 hours after surgery .Results No statistical difference was found in the incidence and severity of muscle fasciculations between the dexmedetomidine group and the control group （ P〉0.05）.Muscle fasciculations were not related to postoperative myalgia （P 〉0.05）.The dexmedetomidine group showed 42.9%incidence of postoperative myalgia than the control （50%）, although no statistical difference was seen （P〉0.05）.The dose of succinylcholine used in the dexmedetomidine group was significantly lower than that in the con -trol group （P〈0.01）.Conclusions Pretreatment of dexmedetomidine can not relieve succinylcholine -induced muscle fasciculations .Dexmedetomidine can not remarkably affect the incidence and severity of postoperative myalgia but can re -duce the dose of succinylcholine .