罗库溴铵用于全麻患者快速气管插管的临床观察

The application of rocuronium in rapid tracheal intubation for patients under general anesthesia

目的观察2倍ED95穴0.6mg蛐kg雪、3倍ED95穴0.9mg蛐kg雪剂量的罗库溴铵在全麻快诱导气管插管时的起效时间、肌松程度及其插管条件,并与琥珀胆碱对照。方法90例病人随机分为3组,每组30例。依次静脉注射咪唑安定0.04mg蛐kg、异丙酚2mg蛐kg,芬太尼4μg蛐kg和肌松药,肌松药Ⅰ组给罗库溴铵0.6mg蛐kg、Ⅱ组给罗库溴铵0.9mg蛐kg,Ⅲ组给琥珀胆碱1.5mg蛐kg。对尺神经作4个成串刺激(TOF),连续监测拇收肌收缩情况,待TOF第1个颤搐反应高度(T1)完全消失时行气管插管。记录每次刺激后T1值、起效时间(T1消失时间)熏并评估插管条件。同时观察心率、血压等心血管反应作为解迷走神经反应的指标。结果Ⅰ组与Ⅱ组、Ⅲ组比较,在各个时间段每次刺激后的衰减幅度和肌松阻滞程度明显较慢(P<0.01)。起效时间琥珀胆碱组为(64±13)s,0.9mg蛐kg罗库溴铵组为(99±31)s,而0.6mg蛐kg罗库溴铵组时间最长,为(135±40)s。罗库溴铵两组之间比较差别有显著性意义(P<0.01);3组气管插管条件按照Cooper法评分标准均可得到8～10分,优良率100%。静注肌松药后1min、插管前、插管后5min均无明显的心血管不良反应。结论0.9mg蛐kg罗库溴铵起效时间和插管条件比0.6mg/kg罗库溴铵更接近琥珀胆碱,副作用少,适宜快诱导插管。

Objective To observe the onset time, extent of muscular relaxing and intubating conditions of 2×ED95(0.6mg/kg) and 3×ED95(0.9mg/kg) rocuronium in rapid tracheal intubation for patients under general anesthesia. Methods Ninety patients were under general anesthesia and were intravenously injected with midazolam 0.04mg/kg, propofol 2mg/kg, fentanyl 4μg/kg and muscular relaxants. Patients were then randomly divided into three groups (n=30): patients in groupⅠ were given rocuronium 0.6mg/kg as muscular relaxant, groupⅡwere given rocuronium 0.9 mg/kg and group Ⅲ were given succinylcholine 1.5mg/kg. The movement of adductor pollicis muscle was continuously measured by stimulating the ulnar nerve in a train-of-four (TOF) mode. Then endotracheal intubation was performed immediately after T1 disappeared. T1 and onset times (T1 disappearing time) were recorded after every stimulation and intubating conditions were evaluated. HR and BP were observed as index of relieving of vague nerve reaction in three groups. Results Grade of T1 twitch depression and muscular blocking were much slower in group I compared with group Ⅱand group Ⅲ (P<0.01). Among 3 groups for the onset time: group III<group II<group I(P<0.01). The intubating conditions for all 3 groups were scored 8～10 by measuring with Cooper standard, and ratio of excellence was 100% in three groups. There were no significant changes on cardiovascular effects after muscular relaxant infusion, before tracheal intubation and 5min after tracheal intubation for all 3 groups. Conclusion Compared with 0.6mg/kg rocuronium, 0.9mg/kg rocuronium is a good choice for rapid tracheal intubation, the onset time and intubating conditions, of which are similar to those of succinglcholine.