不同呼末浓度七氟醚对老年患者顺式阿曲库铵肌松效应的影响

中国临床药理学与治疗学 ›› 2014, Vol. 19 ›› Issue (9): 1033-1036.

不同呼末浓度七氟醚对老年患者顺式阿曲库铵肌松效应的影响

项小兵¹, 连燕虹¹, 吴盈利¹, 袁晓红¹, 柳兆芳²

¹ 浙江省肿瘤医院麻醉科,杭州 310022,浙江;
² 皖南医学院附属弋矶山医院麻醉科,芜湖 241000,安徽

收稿日期:2014-02-22 修回日期:2014-08-13 出版日期:2014-09-26 发布日期:2014-09-26
通讯作者: 连燕虹,女,副主任医师,研究方向:麻醉与应激。 E-mail: yanhong_lian@163.com
作者简介:项小兵,男,硕士,研究方向:临床麻醉与药理。 E-mail: 237607488@qq.com

Effects of different end-tidal sevoflurane concentration on cisatracurium produced neuromuscular blockade in elderly patients

XIANG Xiao-bing¹, LIAN Yan-hong¹, WU Ying-li¹, YUAN Xiao-hong¹, LIU Zhao-fang²

¹ Department of Anesthesiology,Zhejiang Cancer Hospital,Hangzhou 310022,Zhejiang,China;
² Department of Anesthesiology,Yijishan Hospital,Wannan Medical College,Wuhu 241001,Anhui,China

Received:2014-02-22 Revised:2014-08-13 Online:2014-09-26 Published:2014-09-26

摘要/Abstract

摘要： 目的探讨不同呼末浓度七氟醚对老年患者顺式阿曲库铵肌松效应的影响。方法 45例择期行开腹手术的老年患者,ASAⅡ~Ⅲ级,随机分为3组,每组15例:七氟醚呼末浓度 0.5 MAC(肺泡最低有效浓度)组(S1组)、七氟醚呼末浓度 1.0 MAC组(S2组)和丙泊酚组(P组)。P组常规静脉诱导,诱导后静注顺苯磺酸阿曲库铵 0.15 mg/kg,待T₁(第一个肌颤搐)降至5%时行气管内插管;S1组先吸入8%浓度七氟醚并调节使其呼末浓度稳定于0.5MAC,余同P组;S2组呼末七氟醚浓度稳定于1.0MAC,余同S1组。术中维持分别采用全凭静脉(P组)和七氟醚持续吸入(S1组0.5MAC、S2组1.0MAC)。记录各组注入顺苯磺酸阿曲库铵后的插管时间、起效时间、TOF(四个成串刺激)无反应时间、阻滞维持时间、T₁25%恢复时间、T₁75%恢复时间、恢复指数、TOF70%恢复时间及血液动力学影响。结果三组患者插管时间、起效时间及血液动力学差异均无统计学意义(P>0.05)。顺式阿曲库铵肌松阻滞期:与P组比较,S1组T₁25%恢复时间显著延长(P<0.05),TOF无反应时间、阻滞维持时间有所延长,但差异无统计学意义(P>0.05);S2组TOF无反应时间、阻滞维持时间及T₁25%恢复时间显著延长(P<0.05);与S1组比较,S2组T₁25%恢复时间延长(P<0.05)。顺式阿曲库铵肌松恢复期:与P组比较,S1组、S2组T₁75%恢复时间、恢复指数、TOF70%恢复时间均显著延长(P<0.05);与S1组比较,S2组T₁75%恢复时间、TOF70%恢复时间显著延长(P<0.05)。结论老年患者吸入七氟醚时,顺式阿曲库铵的起效时间不变,肌松阻滞时间和恢复时间延长,且与七氟醚吸入浓度有关。

关键词: 七氟醚, 顺式阿曲库铵, 神经肌肉阻滞, 老年人

Abstract: AIM: To discuss the effects of different end-tidal sevoflurane concentration on cisatracurium-produced neuromuscular blockade in the elderly. METHODS: Forty-five patients of ASAⅡ-Ⅲ undergoing abdominal surgery were randomly divided into three groups with 15 cases each,all patients were received general anesthesia. Anesthesia with propofol infusion (group P),0.5MAC sevoflurane (group S1) or 1.0 MAC sevoflurane inhalation (group S2) respectively. Group P,routine intravenous anesthesia induction,injectioned cisatracurium 0.15 mg/kg after anesthesia induction,and intubation was performed as soon as the T1 fell below 5%; group S1,inhalated 8% sevoflurane firstly,and regulated inhalation concentration to make the end-tidal sevoflurane concentration 0.5MAC,others same with group P; group S2,the end-tidal sevoflurane concentration 1.0MAC,others same with group S1. After performed tracheal intubation,groups to receive propofol TIVA(group P)or inhalation sevoflurane(group S1,group S2),the end-tidal sevoflurane concentration of group S1 was 0.5MAC,the end-tidal sevoflurane concentration of group S2 was 1.0MAC. The intubation time,the onset time,no-response time,the time of T₁ 5% recovery,the time of T₁ 25% recovery,the time of T₁ 75% recovery,recovery index,the 0.70 recovery time of TOF(T₄/T₁) and hemodynamic effects were recorded. RESULTS: There were no significant differences in the intubation time,the onset time and hemodynamics among three groups (P>0.05). Compared with group P,the time of T₁ 25% recovery was significant longer in group S1 (P<0.05). No-response time,the time of T₁5% recovery and the time of T₁ 25% recovery were significant longer in group S2 (P<0.05). Compared with group S1,the time of T₁ 25% recovery was significant longer in group S2 (P<0.05). Compared with group P,the time of T₁ 75% recovery,the 0.70 recovery time of TOF and recovery index were significant longer in group S1,S2 (P<0.05). Compared with group S1,the time of T₁ 75% recovery and the 0.70 recovery time of TOF in group S2 were longer(P<0.05). CONCLUSION: Sevoflurane inhalation can significantly enhance the neuromuscular block effect of cisatracurium in dose-dependent manner for the elderly, but the onset time is similar.

Key words: sevoflurane, cisatracurium, neuromuscular blockade, aged

中图分类号:

R614

项小兵, 连燕虹, 吴盈利, 袁晓红, 柳兆芳. 不同呼末浓度七氟醚对老年患者顺式阿曲库铵肌松效应的影响[J]. 中国临床药理学与治疗学, 2014, 19(9): 1033-1036.

XIANG Xiao-bing, LIAN Yan-hong, WU Ying-li, YUAN Xiao-hong, LIU Zhao-fang. Effects of different end-tidal sevoflurane concentration on cisatracurium produced neuromuscular blockade in elderly patients[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2014, 19(9): 1033-1036.

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