新斯的明拮抗维库溴铵残余肌松的量效反应与时机

The dose-effect response and timing of neostigmine's antagonism to vecuronium remnant myasone

[目的]探讨新斯的明拮抗维库溴铵残余肌松(RNMB)在更年期手术患者中的量效反应与时机。[方法]选择全麻手术患者60例,随机分为Ⅰ、Ⅱ、Ⅲ三组。常规静脉全麻诱导,丙泊酚复合瑞芬太尼恒速泵注维持麻醉,间断静注维库溴铵。术毕四次成串刺激(TOF)第二个颤搐反应(T2)自发恢复时,给予神经肌肉阻滞拮抗药新斯的明,三组剂量分别为0.02 mg/kg、0.03 mg/kg、0.04 mg/kg。记录注药后四个成串刺激比值(TOFR)恢复到0.7、0.9的时间和T1恢复到75%(恢复指数RI)的时间。记录给药后5 min内心率(P)和平均动脉血压(MAP)的变化。[结果]Ⅱ、Ⅲ组拮抗后TOFR恢复到0.7、0.9的时间和RI时间明显短于Ⅰ组,差异有统计学意义(P <0.05),Ⅱ、Ⅲ组差异无统计学意义(P> 0.05)。拮抗后1～2 min时Ⅲ组心率明显增快,差异有统计学意义(P <0.05),Ⅰ、Ⅱ组差异无统计学意义(P> 0.05);三组患者拮抗前后MAP变化差异无统计学意义(P> 0.05)。[结论]在T2自发恢复时给予新斯的明拮抗维库溴铵神经肌肉阻滞是安全可行的,更年期患者推荐剂量为0.03 mg/kg。

[Objective]To explore the effects of neostigmine antagonistic vasopressin(RNMB) in patients undergoing climacteric surgery.[Methods]60 patients with general anesthesia surgery were randomly divided into groupⅠ,Ⅱ,Ⅲ.Routine intravenous general anesthesia induction,propofol combined with remifentanil constant speed pump injection to maintain anesthesia,intermittent static injection of vecuronium.When the secondary twitch response(T2) spontaneously recovered after four times of TOF stimulation(TOF),neuromuscular antagonist neostigmine was given.The doses in the three groups were 0.02 mg/kg,0.03 mg/kg,0.04 mg/kg,respectively.The time of recovery to 0.7,0.9 and T1 to 75%(recovery index RI) were recorded.Changes in heart rate(P) and mean arterial blood pressure(MAP) were recorded 5 minutes after administration.[Results]Group Ⅱ and Ⅲ after the antagonism TOFR recovered to 0.7,0.9 and RI time significantly shorter than group Ⅰ,the difference was statistically significant(P<0.05),there was no statistically significant difference group Ⅱ and Ⅲ(P>0.05).Antagonism after 1 ~ 2 min when heart rate significantly faster group Ⅲ,the difference was statistically significant(P<0.05),there was no statistically significant difference group Ⅰ and Ⅱ(P>0.05);There was no statistically significant difference in MAP changes before and after antagonism between the three groups(P>0.05).[Conclusion]It is safe and feasible to give neostigmine antagonistic vecuronium neuromuscular block in spontaneous recovery of T2,and the recommended dose for menopausal patients is0.03 mg/kg.