摘要
目的比较同等麻醉深度下七氟烷和丙泊酚对顺式阿曲库铵肌松作用的影响。方法将60例择期行耳鼻喉科手术的患者随机分为4组（PA、PB、SA、SB组,各15例）,行健忘镇痛慢诱导气管插管。PA和PB组术中维持采用丙泊酚靶控输注,SA和SB组术中维持采用七氟烷持续吸入,研究期间4组均维持同等麻醉深度[脑电双频谱指数（BIS）值40~50]。麻醉平稳后PA和SA组单次给予2倍95%有效剂量（ED95,0.1mg/kg）顺式阿曲库铵,PB和SB组单次给予3倍ED95剂量（0.15 mg/kg）顺式阿曲库铵。采用4个成串刺激（TOF）方式监测拇内收肌的收缩反应。记录各组注入顺式阿曲库铵后阻滞起效时间T0,TOF无反应期TR0,TOF后第一个肌颤搐T1恢复到5%、25%、75%和95%的时间（T5、T25、T75、T95）,TOF比值恢复到70%的时间（TR70）以及肌松恢复指数（RI）。结果 SA和PA、SB和PB组间T0差异均无统计学意义（P〉0.05）;SA组TR0、T25、T75、T95、TR70、RI与PA组相比明显延长（P〈0.05）,分别延长62%、49%、45%、47%、49%、33%;上述指标在SB组较PB组明显延长（P〈0.05）,分别延长26%、26%、29%、36%、39%、48%。结论同丙泊酚相比,七氟烷可明显延长顺式阿曲库铵的维持时效,其深度阻滞和外科阻滞期明显延长,同时恢复时程亦相应延长,并增加其残余肌松作用。
Objective To investigate the influence of propofol target controlled infusion anesthesia（TIVA） and sevoflurane anesthesia on the neuromuscular block effect of cisatracurium.Methods Sixty ASA class Ⅰ or Ⅱ patients,scheduled for ENT（ears,nose,throat） surgery were randomly divided into four groups of equal number to receive either 0.1mg/kg cisatracurium under sevoflurane（SA） or propofol TIVA（PA）,or 0.15mg/kg cisatracurium under sevoflurane（SB） or propofol TIVA（PB）.The bispectral index（BIS） was between 40 and 50 during maintenance of anesthesia.Thumb adductorius contractile response was monitored with TOF stimulation.Neuromuscular blocking variables included onset time（T0）,no-response time（TR0）,the time to recovery of T1 to 5%,25%,75% and 95% of control（T5,T25,T75,T95）,the TOF ratio to70%（TR70） and recovery index（RI） were monitored.Results No difference was found in the onset time between groups PA and SA,and groups PB and SB（P0.05）.The unresponsive time was prolonged by 62% in group SA compared with PA,and 26% in group SB compared with PB（P0.05）.The time of T1 recovering 75% of the control（T75） was prolonged by 45% in group SA compared with PA,and 29% in group SB compared with PB（P0.05）.The time of T1 recovering 95% of the control value（T95） was prolonged by 47% in group SA compared with PA,and 36% in group SB compared with PB（P0.05）.The recovery index（RI） was prolonged by 33% in group SA compared with PA,and 48% in group SB compared with PB（P0.05）.Conclusion Compared with propofol TIVA,sevoflurane anesthesia may enhance the neuromuscular block effect of cisatracurium and significantly prolong the clinical recovery duration of cisatracurium.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2011年第9期973-975,共3页
Medical Journal of Chinese People's Liberation Army
