胸科手术中顺阿曲库铵维持深度肌松的静脉输注剂量

Dose of intravenously infused cisatracurium for maintenance of deep neuromuscular blockade during thoracic surgery

目的探讨胸科手术中顺阿曲库铵维持深度肌松的静脉输注剂量。方法择期全麻下行胸科手术患者,年龄18~64岁,ASA分级Ⅰ或Ⅱ级,入室后连接肌松监测仪,完成肌松定标、麻醉诱导后,术中恒速静脉输注顺阿曲库铵维持肌松深度[强直刺激后计数(PTC)≤5]。采用改良Dixon序贯法进行试验,第1例输注速率为0.12 mg·kg^(-1)·h^(-1),若术中PTC持续为0或维持PTC≤5,则下一例输注速率递减0.01 mg·kg^(-1)·h^(-1);直至第n例患者术中出现PTC>5,将第n例和第n-1例剂量的均数作为初始剂量,以0.005 mg·kg^(-1)·h^(-1)为梯度进行上下调整,以得到6次剂量骑跨,计算6个剂量的中位数为顺阿曲库铵维持95%的患者深度肌松的有效剂量(ED95)。结果共22例患者完成本试验。静脉输注顺阿曲库铵维持深度肌松的ED95为0.108 mg·kg^(-1)·h^(-1)(95%可信区间0.105~0.125 mg·kg^(-1)·h^(-1))。结论胸科手术中静脉输注顺阿曲库铵维持深度肌松的剂量为0.108 mg·kg^(-1)·h^(-1)。

Objective To investigate the dose of intravenously infused cisatracurium for the maintenance of deep neuromuscular blockade during thoracic surgery.Methods Patients of American Society of Anesthesiologists physical statusⅠorⅡ,aged 18-64 yr,scheduled for elective thoracic surgery under general anesthesia,were studied.The patients were connected to a muscle relaxation monitor after entering the operating room.After the completion of muscle relaxant calibration and anesthesia induction,cisatracurium was intravenously infused at a constant rate to maintain deep neuromuscular blockade(post-tetanic count[PTC]≤5).The infusion rate was calculated by modified Dixon up-and-down method.The first patient received cisatracurium at 0.12 mg·kg^(-1)·h^(-1).If the PTC was 0 or was maintained≤5 continuously,the infusion rate was decreased 0.01 mg·kg^(-1)·h^(-1) in the next patient,until PTC was>5 during operation.The mean dose for the patient was used as initial dose.Then the infusion rate was increased/decreased by 0.005 mg·kg^(-1)·h^(-1).The 95%effective dose of cisatracurium(ED95)was the median of 6 thresholds.Results A total of 22 cases completed the study.The ED95 of continuous intravenous infusion of cisatracurium for the maintenance of deep neuromuscular blockade was 0.108 mg·kg^(-1)·h^(-1)(95%confidence interval 0.105-0.125 mg·kg^(-1)·h^(-1)).Conclusion The dose of intravenous infusion of cisatracurium for the maintenance of deep neuromuscular blockade during thoracic surgery is 0.108 mg·kg^(-1)·h^(-1).