右美托咪定对罗库溴铵起效时间和临床时效的影响

Effects of dexmedetomidine on the onset time andclinical duration of rocuronium

目的 观察右美托咪定对罗库溴铵起效时间和临床时效的影响.方法 选择择期在静吸复合麻醉下行妇科腹腔镜手术的患者40例,年龄20~55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20例.2组患者均静脉注射舒芬太尼0.4 μg/kg、丙泊酚2 mg/kg和罗库溴铵0.6 mg/kg行麻醉诱导,右美组在诱导前经静脉泵注射右美托咪定0.5 μg/kg,10 min内匀速注射完毕,麻醉期间以0.5 μg·kg-1·h-1持续输注泵注射,对照组注射等量生理盐水.记录基础、给右美托咪定后、气管插管前、插管后即刻、插管后5 min、插管后10 min、插管后30 min患者的收缩压、舒张压和心率,采用加速度法4个成串刺激（TOF）监测肌松,记录罗库溴铵的起效时间和无反应时间.气管插管后2组均吸入七氟烷维持麻醉.结果 2组间罗库溴铵起效时间和无反应时间的差异无统计学意义（P〉0.05）,2组各时间点收缩压和舒张压的差异均无统计学意义（P值均〉0.05）.对照组心率在插管前、插管后30 min明显降低,差异有统计学意义（P值均〈0.05）,右美组心率在给药后、插管前、插管后5 min、插管后10 min、插管后30 min,对照组心率在插管后10 min明显降低,差异有统计学意义（P值均〈0.01）.结论 小剂量右美托咪定对罗库溴铵的起效时间和临床时效无影响,右美托咪定对心率的影响更明显.

Objective To investigate effects of dexmedetomidine on the onset time and clinical duration of rocuronium.Methods A total of 40 ASA Ⅰ-Ⅱ patients aging 25-55 who scheduled for laparoscopic surgery under combined anesthesia were divided into a dexmedetomidine group and a control group （n=20）.Anesthesia induction was conducted through intravenous injection of 0.4 μg/kg sufentanil,2 mg/kg propofol and 0.6 mg/kg rocuronium.Before anesthesia induction,the dexmedetomidine group was intravenously injected with 0.5 μg/kg dexmedetomidine within 10 min,followed by intravenous infusion of 0.5 μg·kg-1·h-1 dexmedetomidine during anesthesia.The control group was injected with the same volume of normal saline.The onset time and clinical duration of rocuronium were recorded.The blood pressure and heart rate （HR） were recorded before treatment （T0）,after dexmedetomidine injection （T1）,before intubation （T2）,immediately after intubation （T3）,5 min after intubation （T4）,10 min after intubation （T5）,and 30 min after intubation （T6）.The onset time and non-response time of rocuronium were recorded using the four-train stimulation （TOF）.Results There were no significant difference in terms of the onset time and non-response time of rocuronium,systolic and diastolic pressures between the two groups （all P〉0.05）.The control group showed remarkable decreases in HR on T2 and T6 compared with those on T0 （all P〈0.05）.The dexmedetomidine group presented significantly reduced HR on T1,T2,T4,T5 and T6,while the control group showed markedly reduced HR on T5 （all P〈0.05）.Conclusions A small dose of dexmedetomidine does not affect the onset time and clinical duration of rocuronium but may present stronger effects on HR.