【摘要】 目的探讨不同剂量国产罗库溴铵用于全身麻醉诱导插管和维持过程中的肌肉松弛效应和血流动力学变化。方法选择择期于全身麻醉下行手术的患者44例,美国麻醉医师学会(ASA)分级Ⅰ或Ⅱ级。采用静脉注射咪达唑仑、靶控输注丙泊酚和瑞芬太尼进行麻醉诱导,应用肌肉松弛监测仪(TOF-Watch)定标稳定后以单刺激(0.1Hz)测定患者的肌肉松弛程度。所有患者均予单次静脉注射罗库溴铵后完成气管插管,以靶控输注丙泊酚和瑞芬太尼维持麻醉深度。根据罗库溴铵的注射剂量将患者分为0.6mg/kg组和0.9mg/kg组。观察两组患者的肌肉松弛起效时间和气管插管条件,记录注射罗库溴铵后患者的收缩压(SBP)、舒张压(DBP)、心率(HR)、脉搏血氧饱和度(SpO2)。结果试验最终纳入患者40例,每组各20例。两组患者间最大肌肉松弛起效时间、肌颤搐最大抑制率、恢复指数、插管条件分级及给予肌肉松弛药至完成插管时间的差异均无统计学意义(P值均>0.05),0.9mg/kg组的临床维持时间和75%恢复时间均较0.6mg/kg组显著延长(P值均<0.05)。两组患者间麻醉诱导前和注药即刻及注药后1、3、5、10min各时间点,SBP、DBP、HR、SpO2的差异均无统计学意义(P值均>0.05)。两组患者注药即刻及注药后1、3、5、10min各时间点,SBP、DBP、HR均较同组基础值显著降低(P值均<0.05);两组患者注药后1、3、5、10min各时间点,SBP、DBP、HR、SpO2与同组注药即刻比较,差异均无统计学意义(P值均>0.05)。两组患者均无不良反应发生。结论国产罗库溴铵可安全有效地应用于临床。单次注射罗库溴铵0.9mg/kg后肌肉松弛起效时间与单次注射罗库溴铵0.6mg/kg相似,且临床维持时间较长。目的探讨不同剂量国产罗库溴铵用于全身麻醉诱导插管和维持过程中的肌肉松弛效应和血流动力学变化。方法选择择期于全身麻醉下行手术的患者44例,美国麻醉医师学会(ASA)分级Ⅰ或Ⅱ级。采用静脉注射咪达唑仑、靶控输注丙泊酚和瑞芬太尼进行麻醉诱导,应用肌肉松弛监测仪(TOF-Watch)定标稳定后以单刺激(0.1Hz)测定患者的肌肉松弛程度。所有患者均予单次静脉注射罗库溴铵后完成气管插管,以靶控输注丙泊酚和瑞芬太尼维持麻醉深度。根据罗库溴铵的注射剂量将患者分为0.6mg/kg组和0.9mg/kg组。观察两组患者的肌肉松弛起效时间和气管插管条件,记录注射罗库溴铵后患者的收缩压(SBP)、舒张压(DBP)、心率(HR)、脉搏血氧饱和度(SpO2)。结果试验最终纳入患者40例,每组各20例。两组患者间最大肌肉松弛起效时间、肌颤搐最大抑制率、恢复指数、插管条件分级及给予肌肉松弛药至完成插管时间的差异均无统计学意义(P值均>0.05),0.9mg/kg组的临床维持时间和75%恢复时间均较0.6mg/kg组显著延长(P值均<0.05)。两组患者间麻醉诱导前和注药即刻及注药后1、3、5、10min各时间点,SBP、DBP、HR、SpO2的差异均无统计学意义(P值均>0.05)。两组患者注药即刻及注药后1、3、5、10min各时间点,SBP、DBP、HR均较同组基础值显著降低(P值均<0.05);两组患者注药后1、3、5、10min各时间点,SBP、DBP、HR、SpO2与同组注药即刻比较,差异均无统计学意义(P值均>0.05)。两组患者均无不良反应发生。结论国产罗库溴铵可安全有效地应用于临床。单次注射罗库溴铵0.9mg/kg后肌肉松弛起效时间与单次注射罗库溴铵0.6mg/kg相似,且临床维持时间较长。更多还原

【Abstract】 Objective To evaluate the muscle-relaxation and hemodynamic effects of different doses of domestic rocuronium during induction and maintenance of general anesthesia.Methods According to thedose of rocuronium,44 American Society of Anesthesiologists (ASA) gradeⅠorⅡpatients scheduled for elective operation under general anesthesia were randomly divided into 0.6 mg/kg group and 0.9 mg/kg group. Anesthesia was induced with midazolam intravenously and propofol and remifentanil by target controlled infusion.After a single injection of rocuronium was administerred at its corresponding dose, endotracheal intubation was completed in all patients. Continuous intravenous injection of propofol and remifentanil were given to maintain intraoperative anesthesia depth. Muscle-relaxation effect was measured by neuromuscular monitoring (TOF-Watch) in single twitch mode (0.1 Hz). The onset time of neuromuscular blockade and endotracheal intubation condition were recorded. Systolic blood pressure (SBP),diastolic blood pressure (DBP), heart rate (HR) and saturation of blood oxygen (SpO2)were also observed. Results Forty patients were enrolled finally (n=20 each group). The onset time, maximum inhibition rate, recovery index of neuromuscular blockade, intubation condition classification and the time needed for intubation between two groups had no significant differences (all P>0.05). The recovery index and 75% recovery time in 0.9 mg/kg group were significantly longer than 0.6 mg/kg group (all P<0.05). There were no significant differences in SBP, DBP, HR or SpO2 before induction of anesthesia,when drug administration and 1,3, 5 and 10 min after drug administration between two groups (all P>0.05). Compared with baseline, SBP, DBP and HRwere significantly decreased,when drug administration and 1,3, 5 and 10 min afterdrug administration in all patients (P<0.05). Comparedwith the values ofdrug administration, SBP, DBP, HR and SpO2 at 1,3, 5 and 10 min afterdrug administration were not obviously different (all P>0.05). No adverse effects were found in the two groups. Conclusion Thedomestic rocuronium can be safely and effectively used in clinic anesthesia. The onset time of neuromuscular blockade is similar after applying 0.9 mg/kg and 0.6 mg/kg rocuronium. The maintenance time of 0.9 mg/kg rocuronium is longer than 0.6 mg/kg rocuronium. (Shanghai Med J,2013,36:316-319)更多还原