发热对全凭静脉麻醉患者顺苯阿曲库铵肌松效应的影响

Effect of fever on ciprofloxacurium muscle relaxant in patients with total intravenous anesthesia

目的探讨发热对全凭静脉麻醉患者顺苯阿曲库铵肌松效应的影响。方法 2014年12月～2018年5月中山市中医院及中山市西区医院拟在全凭静脉麻醉手术患者64例,性别不限,年龄18～64岁,BMI18～22kg/m^2,ASA分级Ⅱ～Ⅲ级,根据患者术前体温分为两组(n=32):对照组(术前体温正常组,C组)和发热组(术前发热组,H组)。采用静脉注射咪达唑仑0.02mg/kg,异丙酚2.5mg/kg,睫毛反射消失后,顺苯阿曲库铵0.15mg/kg后静注瑞芬太尼2μg/kg,于30s后气管插管,机械通气,持续输注异丙酚及瑞芬太尼维持麻醉,采用T_OF-Watch SX加速度仪监测肌松程度,记录肌松药的起效时间、肌颤搐最大抑制度、临床作用时间、恢复指数。记录患者麻醉前(T_0)、气管插管后(T_1)、手术结束时(T_2)、出手术室时(T_3)体温及心率(HR)。结果 H组1例患者因手术原因,剔除出研究。H组顺苯阿曲库铵起效时间较C组延长,起效时间为(4.9±0.1)min,肌颤搐最大抑制程度较C组降低,为(96±1)%,临床作用时间较C组缩短,为(50±3)min,恢复指数减小(10.0±0.3)min(P <0.05)。H组患者T_0、T_1、T_2体温及HR高于C组,T_3差异无统计学意义。结论发热因素可减弱全凭静脉麻醉患者顺苯阿曲库铵肌松效应。

Objective To explore effect of fever on ciprofloxacurium muscle relaxant in patients with total intravenous anesthesia. Methods 64 patients, being operated on solely by intravenous anesthesia in Zhongshan Hospital of Traditional Chinese Medicine and Zhongshan West Hospital from December 2014 to May 2018 at the age of 18-64, BMI 18-22kg/m2, ASA Classification II-III, were divide into fever group (preoperative fever group, group H) and control group (preoperative body temperature normal group, group C), with 32 patients in each group. Intravenous injection of midazolam (0.02mg/kg) and propofol (2.5mg/kg) were used. After the disappearance of eyeliner reflex, ciprofloxacurum (0.15mg/kg) was intravenously injected with remifentanil (2μg/kg). After 30s, the patients were intubated and mechanically ventilated. The degree of muscle relaxation was monitored with the tof-watch SX accelerometer, and the onset time of muscle relaxant, maximum inhibition degree of muscle twitching, clinical action time, and recovery index were recorded. Body temperature and heart rate (HR) before anesthesia (T0), after endotracheal intubation (T1), at the end of surgery (T2), and at the time of exit from the operating room (T3) were recorded. Results One patient in group H was excluded from the study due to surgical reasons. The onset time of cis-atracurium in group H was longer than that in group C (4.9±0.1)min, the maximum inhibitory degree of twitch was lower than that in group C (96±1)%, the clinical action time was shorter than that in group C (50±3)min, and the recovery index was reduced (10.0±0.3)min (P < 0.05). T0, T1 and T2 body temperatures and HR of patients in group H were higher than those in group C, and T3 differences were not statistically significant. Conclusion Febrile factors may attenuate the cisphenacurium muscle relaxant effect in patients undergoing total intravenous anesthesia.