【摘要】 目的探讨顺式阿曲库铵(Cisa)应用于阻塞性黄疸患者麻醉时的肌松效应和安全性。方法 40例阻塞性黄疸伴肝功能不全手术患者均分为Ⅰ组(Cisa,2×ED95)和Ⅱ组(Cisa,3×ED95);对照组为上腹部手术患者40例,均分为Ⅲ组(Cisa,2×ED95)和Ⅳ组(Cisa,3×ED95)。采用4个成串刺激(TOF)刺激前臂尺神经,记录各组肌肉松弛效应参数和注射Cisa前后生命体征的变化及插管条件。术中TOF第一个颤搐反应的高度(T1)10%恢复时,补充注射顺式阿曲库铵0.05 mg/kg,记录术中5次追加顺式阿曲库铵临床有效作用时间(S1、S2、S3、S4、S5)。麻醉维持采用间断静注芬太尼复合丙泊酚6~8 ml.kg-1.h-1及瑞芬太尼0.1~0.2μg.kg-1.min-1泵注。术毕观察并记录各组肌松恢复情况。结果Ⅰ、Ⅲ组的肌松参数与Ⅱ、Ⅳ组相仿。与Ⅰ、Ⅲ组比较,Ⅱ、Ⅳ组插管条件为优的比率较高,起效时间较短,诱导剂量临床有效作用时间较长(P<0.05)。结论 Cisa可以安全用于阻塞性黄疸患者的麻醉。麻醉诱导用3×ED95剂量Cisa的肌松效果比2×ED95更好。更多还原

【Abstract】 Objective To observe the neuromuscular blockade and safety of applying cisatracurium(Cisa) in surgical patientsts with obstructive jaundice(OJ).Methods Fourty OJ patients were equally divided into groups of A(Cisa,2×ED95) and B(Cisa,3×ED95).Another 40 cases without OJ were divided into groups of C(Cisa,2×ED95) and D(Cisa,3×ED95).The anesthesia was inducted with fentanyl 2-4μg/kg,propofol 2mg/kg and maintained with propofol 6-8ml·kg-1·h-1,remifentanil 0.1-0.2μg·kg-1·min-1.The changes of life parameters before and after induction and intubation conditions were recorded.The meuromuscular block was monitored with TOF stimulation model.Results The outcomes of neuromuscular blockades of groups of A and B were similar to those of groups of C and D.Compared to groups of A and C,the excellent intubation condition rate was higher,onset time was shorter,and action time was longer in groups of B and D(P<0.05).ConclusionCisa can be used safely in the patients with OJ.A dose of 3×ED95 Cisa has a better neuromuscular blockade than that of 2×ED95.更多还原