顺式阿曲库铵与罗库溴铵在全麻中的效果比较

目的探讨顺式阿曲库铵和罗库溴铵在全麻中的效果比较。方法将360例选择气管插管全身麻醉下行择期手术的患者随机分为对照组和观察组,每组180例。所有患者经静脉注入咪达唑仑0.05 mg/kg、芬太尼3μg/kg、丙泊酚1.0².0 mg/kg进行麻醉诱导,患者意识和睫毛反射消失后,对照组给予罗库溴铵0.6 mg/kg,观察组给予顺式阿曲库铵0.15 mg/kg,之后行气管插管,插管成功后使用七氟烷吸入、间推芬太尼、肌松药维持麻醉深度。比较气管插管条件评级及两组患者麻醉前、麻醉中的平均动脉压(MAP)、脉搏血氧饱和度(SpO2)和心率(HR)的变化,记录临床肌松起效时间、插管时的肌松程度、肌松作用时间、肌松恢复指数及并发症发生情况。结果观察组、对照组的气管插管总有效率分别为97.8%、92.8%,两组比较差异有统计学意义(P<0.05);两组患者术后的MAP、HR和SpO2与术前比较差异无统计学意义(P>0.05);观察组肌松起效时间较长,但作用时间和恢复指数均明显低于对照组,差异有统计学意义(P<0.05);观察组的并发症发生例数明显少于对照组(P<0.05)。结论顺式阿曲库铵用于气管插管时能获得更为满意的插管条件,肌松起效较慢,但持续时间短,不良反应较少,是目前临床上较为理想的肌松剂。     

HPLC-荧光法测定人血清中顺式阿曲库铵的浓度

目的:建立测定人血清中顺式阿曲库铵浓度的方法。方法:血清酸化后采用二氯甲烷液-液萃取法处理,以高效液相色谱(HPLC)-荧光法进样测定,色谱柱为Kromasil100-5C18,流动相为1.0%三氟乙酸-乙腈(58∶42),流速为0.8ml/min,柱温为常温,荧光检测波长分别为280 nm(E x)、320 nm(E m)。结果:顺式阿曲库铵血药浓度在15.625² 000ng/ml范围内线性关系良好(r=0.999 3),平均提取回收率为78.78%2 000ng/ml范围内线性关系良好(r=0.999 3),平均提取回收率为78.78%⁸3.59%,平均方法回收率为98.58%83.59%,平均方法回收率为98.58%¹01.23%,日内、日间RSD均小于10%。结论:本方法操作简便、灵敏度高、重现性好、结果可靠,可满足临床上血清中顺式阿曲库铵血药浓度检测和药动学研究的需要。     

Kardiovaskuläre Effekte nach Bolusapplikation von Cisatracurium

Cisatracurium – one of the ten stereoisomers of atracurium – is an intermediate long-acting non-depolarizing neuromuscular blocking agent. Cardiovascular reactions have been described after administration of cisatracurium or vecuronium in surgical patients. Methods. After approval by our institutional review board, 62 patients (ASA I–II) were randomly assigned to three groups to either receive 3×ED₉₅ or 5×ED₉₅ of cisatracurium or 3×ED₉₀ of vecuronium prior to intubation as a bolus. After oral premedication with 2?mg lormetazepam anaesthesia was induced with thiopental (4–12?mg/kg) and maintained with O₂/N₂O and isoflurane (1.5%–2%). Six minutes after administration of thiopental, patients received the muscle relaxant. Six minutes later 0.1–0.2?mg fentanyl was given and the trachea was intubated. Heart rate (HR) and blood pressure (BP) were monitored every minute. Changes of heart rate or blood pressure?>20% compared to baseline were defined as clinically significant. Results. After application of the study drug, median values of blood pressure and heart rate were stable. For each muscle relaxant, there were several patients who had statistically significant cardiovascular changes. After 3×ED₉₅ cisatracurium, 3 of 21 patients exhibited haemodynamic changes?>20% (2 exhibited hypotension and 1 tachycardia), while in the high-dose cisatracurium group 2 of 21 patients demonstrated a tachycardia that was predetermined to be statistically but not clinically significant. In the vecuronium group, 2 of 20 patients sustained statistically significant hypotension and 1 patient had statistically significant tachycardia. The frequency of all individual cardiovascular changes after the application of the muscle relaxant was not dose-dependent. Conclusion. After the administration of cisatracurium in two different doses (3×ED₉₅ and 5×ED₉₅) or vecuronium (3×ED₉₀) only minor cardiovascular changes were observed. Both drugs proved to be safe for use during induction of anaesthesia in patients ASA I–II. With regard to its cardiovascular effects, cisatracurium shares with vecuronium the requirements of an ideal muscle relaxant.     

顺式阿曲库铵按体表面积给药的量效关系

目的采用单次剂量法测定顺式阿曲库铵(Cis)按体表面积给药的量效关系。方法全身麻醉择期手术患者80例,按体表面积给药剂量的不同随机分为四组(0.7、1.0、1.3、1.6mg/m2),每组20例。记录四个成串刺激中第一个肌颤搐反应(T1)的最大抑制百分率和Cis起效时间。将T1最大抑制百分率进行概率单位转换,单次Cis剂量进行对数转换,建立量效关系回归方程,计算出Cis的ED50、ED75、ED90、ED95值。结果随Cis剂量增加,T1最大抑制百分率增大,起效时间缩短(P0.01);Cis的ED50、ED75、ED90、ED95分别为1.06、1.33、1.64、1.86mg/m2。结论采用单次剂量法按体表面积给药测得Cis的ED50、ED75、ED90、ED95分别为1.06、1.33、1.64、1.86mg/m2,Cis的起效时间随剂量增加而缩短。     

The infusion requirements and recovery characteristics of cisatracurium or atracurium in intensive care patients

Objective To investigate the infusion requirements and recovery characteristics of cisatracurium compared with atracurium when both are administered by prolonged continuous infusion.Design A prospective, randomised, single-blind study.Settings The Intensive Care Unit of the Manchester Royal Infirmary.Patients 20 patients requiring a continuous infusion of a neuromuscular blocking agent to facilitate mechanical ventilation. 12 patients received cisatracurium and 8 received atracurium.Interventions Cisatracurium or atracurium was administered by continuous infusion for a minimum of 24h. The level of neuromuscular blockade was measured by recording the train-of-four responses using acceleromyography, the aim being to maintain 1–2 twitch responses of the adductor pollicis. At the end of the infusion period, the train-of-four was recorded until the ratio was greater than 0.7.Measurements and results The mean infusion rate of cisatracurium was 0.23 mgkg^–1 h^–1, compared to 0.62 mgkg^–1 h^–1. No time-related increase in infusion requirements was seen for either drug. The mean recovery time to a train-of-four ratio greater than 0.7 was the same (46 min). There was no correlation between recovery time and age, duration of infusion or mean infusion rate.Conclusions Cisatracurium provides a satisfactory level of neuromuscular blockade in adult ICU patients at approximately one-third the infusion rate of atracurium and with a similar recovery time.This work was completed with the support of a grant from the Wellcome Foundation ple     

不同剂量顺式阿曲库铵对小儿肌松作用的比较

目的 观察不同剂量顺式阿曲库铵在小儿麻醉中的肌松作用,探讨小儿合适的麻醉诱导剂量及对心血管的影响.方法 选择45例择期手术患儿,年龄2～8岁,美国麻醉医师学会(ASA)分级Ⅰ～Ⅱ级,随机分为3组,每组15例.Ⅰ、Ⅱ、Ⅲ组分别予顺式阿曲库铵0.10、0.15、0.20 mg/kg.麻醉诱导:咪达唑仑0.2 mg/kg,芬太尼2μg/kg,丙泊酚2～4 mg/kg.麻醉维持:吸入N_2O/O_2(50/50)和2%七氟烷,经静脉微泵持续注射丙泊酚2 mg·kg~(-1)·h~(-1),术中根据需要追加芬太尼1μg/kg.采用肌松检测仪对尺神经进行连续4个成串刺激(TOF),观察拇内收肌的加速度变化.记录各组起效时间[肌松药注射毕至第1次颤搐反应(T_1)达最大抑制的时间]、阻滞维持时间(肌松药注射毕至T_1恢复到5%的时间)、临床作用时间(肌松药注射毕至T_1恢复到25%的时间)、体内作用时间(肌松药注射毕至T_1恢复到95%的时间)及恢复指数(T_1从25%恢复至75%的时间).应用多功能监护仪监测注射顺式阿曲库铵前、后的血流动力学变化,同时观察患儿有无皮肤潮红及支气管痉挛等症状.结果 3组间插管条件评估分级、恢复指数的差异均无统计学意义(P值均>0.05).与给药前比较,3组注射顺阿曲库胺后1～5 min的收缩压、舒张压、心率的差异均无统计学意义(P值均>0.05).Ⅱ、Ⅲ组的起效时间显著短于Ⅰ组(P值均<0,05),而Ⅱ组与Ⅲ组间的差异无统计学意义(P>0.05).3组间阻滞维持时间、临床作用时间、体内作用时间的差异均有统计学意义(P值均<0.05).结论 小儿应用咪达唑仑、芬太尼和丙泊酚进行麻醉诱导时,顺式阿曲库铵0.15 mg/kg是理想的诱导剂量.     

不同肌肉松弛剂用于脊柱外科手术麻醉的比较研究

目的：比较脊柱手术麻醉维持期间,持续静脉输注顺式阿曲库铵与罗库溴铵对术中唤醒时间、麻醉恢复时间及苏醒质量的影响。方法：选择我院40例择期行脊柱手术患者ASAⅠ～Ⅱ级,随机分为顺式阿曲库铵组（C组）和罗库溴铵组（R组）,每组20例。术中麻醉维持,C组持续静脉输注顺式阿曲库铵0.05 mg/（kg.h）,R组静脉持续术中罗库溴铵0.3 mg/（kg.h）,两组均采用静吸复合麻醉。观察停止输注肌松药后术中唤醒时间、恢复时间及唤醒质量。结果：C组患者术中唤醒时间为（11.61±2.20）min,麻醉恢复时间为（14.33±2.20）min。R组术中唤醒时间为（16.70±6.02）min,麻醉恢复时间为（20.53±4.01）min,差异有统计学意义（P〈0.05）。两组唤醒质量比较差异无统计意义（P〉0.05）。结论：顺式阿曲库铵组的唤醒时间和恢复时间均短于罗库溴铵组。     

2种麻醉维持方法下小儿苯磺顺阿曲库铵药效学研究

目的:研究全凭静脉、七氟醚静吸复合2种麻醉维持方法下小儿苯磺顺阿曲库铵的药效学。方法:拟在气管插管全身麻醉下行择期颜面、颈部手术的9个月～13岁小儿60例,按麻醉维持方法,分为全凭静脉组(T组)和七氟醚静吸复合组(S组)。麻醉诱导后,单次静脉注射苯磺顺阿曲库铵0.15mg·kg-1,麻醉维持:全部患儿均给予瑞芬太尼15μg·kg-1·h-1、丙泊酚8mg·kg-1·h-1微量泵注入;S组插管后吸入1MAC(最小肺泡内浓度)的七氟醚。以TOF-Watch SX监测仪对尺神经进行连续4个成串刺激(TOF),观察拇内收肌的加速度变化。记录2组起效时间、最大效应持续时间、临床作用时间、恢复指数、体内作用时间及TOFR(T4/T1)恢复到90%的时间(TOFR0.9)。结果:2组起效时间差异无统计学意义(P>0.05);S组最大效应持续时间、临床作用时间、恢复指数、体内作用时间和TOFR0.9均显著长于T组,差异有统计学意义(P<0.05)。结论:七氟醚可增强小儿苯磺顺阿曲库铵的肌松效应,延长恢复时间。     

戊巴比妥钠联合苯磺酸阿曲库铵对大鼠坐骨神经复合肌肉动作电位的影响

摘 要 目的:研究戊巴比妥钠和苯磺酸阿曲库铵对大鼠坐骨神经复合肌肉动作电位（compound muscle action potential,CMAP）的影响。方法: 成年SD大鼠随机分为2组（n=10）,戊巴比妥钠+生理盐水组（PN组）和戊巴比妥钠+苯磺酸阿曲库铵组（PA组）。2组均腹腔注射1%戊巴比妥钠40 mg·kg^-1麻醉,给予戊巴比妥钠8 min时PA组腹腔注射苯磺酸阿曲库铵2.5μg·kg^-1,PN组注射等量生理盐水。而后立即刺激坐骨神经,记录其所支配的腓肠肌的CMAP。刺激强度为0.50 v,波宽0.05 ms,频率10 Hz,每隔5 min重复上述刺激。结果:PN组中,在0.5 v的刺激强度下,T18～28 min时峰峰值降低,而潜伏期延长（与T8 min时比较,P<0.05或0.01）;PA组中,T18～43 min时CMAP峰峰值降低,而潜伏期延长（与T8 min时比较,P<0.05或0.01）;两组比较,PA组T18～43 min时的峰峰值及潜伏期与PN组对应时间点的峰峰值及潜伏期差异有统计学意义（P<0.05或0.01）。结论:戊巴比妥钠或复合苯磺酸阿曲库铵后均可一过性抑制大鼠坐骨神经CMAP,而复合苯磺酸阿曲库后其抑制作用更强。