预注不同剂量米库氯铵对肌松效应的影响

Effects of priming on the neuromuscular block effects of mivacurium：a comparison of different priming doses

目的 观察预先注射（预注）不同剂量米库氯铵对肌松效应的影响。 方法 选择全身麻醉下行择期手术的患者40例，年龄18~60岁，ASA分级Ⅰ、Ⅱ级，按随机数字表法分为4组（每组10例）：对照组（A组）、预注20%的95%有效药物剂量（95% effective dose, ED95）米库氯铵组（B组）、预注30%ED95米库氯铵组（C组）、预注40%ED95米库氯铵组（D组）。丙泊酚联合舒芬太尼麻醉诱导后，A组预注生理盐水，B组、C组和D组分别预注米库氯铵0.014 mg/kg（20%ED95）、0.021 mg/kg（30%ED95）和0.028 mg/kg（40%ED95），预注后2 min，给予剩余插管剂量（A组0.210 mg/kg、B组0.196 mg/kg、C组0.189 mg/kg、D组0.182 mg/kg）。应用四个成串刺激（train of four stimulation, TOF）-Watch加速仪进行肌松监测。观察肌松起效时间、阻滞维持时间、临床作用时间、体内作用时间和恢复指数。 结果 与A组比较， B组、C组和D组米库氯铵起效时间显著缩短［（183±48） s比（141±18）、（132±30）、（117±21） s］（P〈0.05）；B组、C组和D组组间比较，起效时间差异无统计学意义（P〉0.05）；4组间阻滞维持时间、临床作用时间、体内作用时间和恢复指数差异无统计学意义（P〉0.05）。 结论 预注可显著缩短米库氯铵的起效时间，不影响肌松维持和恢复过程，但加大预注剂量未能明显缩短起效时间。

Objective To observe and compare the effects of different priming doses on the neuromuscular block effects of mivacurium. Methods A total of forty patients of ASA Ⅰor Ⅱ, who were scheduled for elective surgery under general anesthesia, were randomized into four groups（n=10）： control group（group A）, 20% 95% effective dose（ED95） of mivacurium as the priming dose group（group B）, 30%ED95 of mivacurium as the priming dose group（group C）, 40%ED95 of mivacurium as the priming dose group（group D）. Following induction of anesthesia with sufentanil and propofol, group A received normal saline, group B received mivacurium 0.014 mg/kg as a priming dose, group C received mivacurium 0.021 mg/kg as a priming dose, group D received mivacurium 0.028 mg/kg as a priming dose. After a 2 min priming time, intubation doses of mivacurium were given（group A 0.210 mg/kg, group B 0.196 mg/kg, group C 0.189 mg/kg, group D 0.182 mg/kg）. TOF-Watch acceleration monitoring instrument was used for muscle relaxation. The time of neuromuscular block onset,duration of peak effect, duration of blockade maintenance, duration of in vivo action and recovery index were recorded. Results Onset time in group B, C and D was similar（P〉0.05）, but was significantly shorter than that in group A[group A （183±48） s, group B（141±18） s, group C（132±30） s, group D（117±21） s]（P〈0.05）. There was no significant difference in duration of peak effect,duration of blockade maintenance,duration of in vivo action and recovery index was observed among the four groups（P〉0.05）. Conclusions Priming with a 2 min priming interval significantly accelerated onset of mivacurium, and it did not affect the clinical duration and recovery profiles of mivacurium. However, there was no significant difference by increasing priming doses.