顺阿曲库铵对髋关节脱位患者手法复位的影响

Influence of cisatracurium on closed reduction for patients suffered posterior hip dislocation

目的观察顺阿曲库铵对髋关节脱位患者手法复位的影响。方法急诊髋关节手法复位患者60例随机分为三组(n=20):A组(七氟醚组)、B组(顺阿曲库铵1组,0.05 mg·kg^(-1))、C组(顺阿曲库铵2组,0.1 mg·kg^(-1))。患者均给予6%~8%七氟醚吸入,意识消失(BIS<60)后置入喉罩通气道,改用2%~3%七氟醚(氧流量2 l·min^(-1))维持。A组静注生理盐水注射液5 ml,不给予肌松药物;B组和C组分别静注不同剂量(0.05 mg·kg^(-1),0.1 mg·kg^(-1))顺阿曲库铵,注射10 min后实施髋关节手法复位。记录患者手法复位时间、呼吸恢复时间、苏醒时间,首次复位成功例数。结果与A组比较,C组患者复位时间显著降低,首次复位成功例数明显升高;B组、C组患者呼吸恢复时间明显升高,苏醒时间显著降低(P<0.05)。与B组比较,C组患者复位时间、苏醒时间显著降低,呼吸恢复时间、首次复位成功例数明显升高(P<0.05)。结论两种剂量顺阿曲库铵均可以改善髋关节脱位患者手法复位首次成功例数;比较而言,0.05mg·kg^(-1)顺阿曲库铵不及0.1 mg·kg^(-1)顺阿曲库铵效果明显,但呼吸恢复时间延长。

Objective To investigate the influence of cisatracurium on closed reduction for patients suffering posterior hip dislocation. Methods 60 cases of patients suffering posterior hip dislocation from emergency were randomly divided into three groups（ n = 20） ： Group A（ the group of sevoflurane）,Group B（ the first group of atracurium,0. 05 mg · kg（-1））,Group C（ the second group of atracurium,0. 1 mg · kg（-1））. All patients were induced with 6% to 8% sevoflurane,and after unconsciousness（ BIS 60）,laryngeal mask airway were inserted properly. Anesthesia was maintained with sevoflurane at the concentration of 2% to 3 % in 100%oxygen（ oxygen flow： 2 l·min（-1））. The patients in Group A were injected with 5 ml normal saline intravenously,without muscle relaxant.The patients in Group B and C were given cisatracurium at the dose of 0.05 mg kg（-1） or 0.1 mg·kg（-1） intravenously 10 min minutes before closed reduction. The recovery time of spontaneous respiration,the time of closed reduction,the consciousness recovery time,the successful cases of closed reduction at first try were recorded.Results Compared with Group A,the reduction time of patients in Group C were significantly decreased,and the successful cases of closed reduction at first try were significantly increased（ P 〈 0. 05）.Compared with Group A,the consciousness recovery time of patients in Group B and C were significantly increased,while the recovery time of spontaneous respiration were significantly decreased（ P 〈 0.05）. Compared with Group B,the reduction time and the recovery time of spontaneous respiration of patients in Group C were significantly decreased,the consciousness recovery time and the successful cases of closed reduction at first try were significantly increased（ P 〈 0. 05）. Conclusions The two doses of cisatracurium can significantly improve the successful cases of closed reduction at first try for patients with posterior hip dislocation. In comparison,the effect if 0.1 mg kg（-1） atracurium seems superior to 0.05 mg kg（-1） atracurium on closed reduction,however,the recovery time of spontaneous respiration were prolonged.