顺式阿曲库胺的药理学研究及临床应用进展

<正>顺式阿曲库胺(cisatracurium)是近年来开发的一种新型的中时效非去极化肌松药,既具备阿曲库铵的代谢特点和肌松时效,又具有维库溴铵对心血管影响小的优点,是较为理想的非去极化肌松药。目前在国外已逐步替代维库溴铵和阿曲库铵而安全的用于临床麻醉,包括小儿、老年患者和肝肾功能不全、严重心血管疾病患者[1]。     

糖尿病因素对患者顺阿曲库铵肌松效应的影响

目的 评价糖尿病因素对患者顺阿曲库铵肌松效应的影响.方法 择期全麻下神经外科手术患者40例,性别不限,年龄30～64岁,体重44～90kg,ASA分级Ⅱ级.根据患者是否合并2型糖尿病分为糖尿病组(D组)和非糖尿病组(ND组),每组20例.患者意识消失后采用Epoch XP神经电生理监测仪,以四个成串刺激方法监测神经肌肉传导功能.T1稳定在100%时静脉注射顺阿曲库铵0.15 mg/kg,肌松起效(T1达到最大抑制程度)后进行气管插管,并行气管插管效果分级,记录顺阿曲库铵起效时间、临床作用时间、恢复时间、恢复指数.结果 与ND组比较,D组患者顺阿曲库铵的起效时间延长(P＜0.05),气管插管效果分级、临床作用时间、恢复时间及恢复指数差异无统计学意义(P＞0.05).结论 糖尿病因素可延长患者顺阿曲库铵的起效时间,但对其维持及恢复无明显影响.

Abstract：

Objective To investigate the effect of diabetes mellitus on neuromuscular blocking effect of cisatracurium in patients. Methods Forty ASA Ⅱ patients, aged 30-64 yr, weighing 44-90 kg, scheduled for neurosurgical operation under general anesthesia, were assigned into 2 groups (n = 20 each): type 2 diabetes mellitus group (group D) and non-diabetes mellitus group (group ND). General anesthesia was induced with midazolam,fentanyl and etomidate. Neuromuscular block was assessed with Epoch XP nerve electrophysiology monitor. A train-of-four stimulation of ulnar nerve was used. Cisatracurium 0.15 mg/kg was injected intravenously over 5 s after T1 was maintained at 100%. Tracheal intubation was performed after the onset of the muscle relaxant. Anesthesia was maintained with iv infusion of propofol 4-8 mg· kg - 1 · h - 1 and remifentanil 0.1-0.3μg· kg - 1 · min - 1. The effect of inmbation was evaluated and graded. The onset time, clinical duration, recovery time and recovery index were recorded. Results The onset time was significantly longer in group D than in group ND ( P ＜ 0.05). There was no significant difference in the clinical duration, recovery time and recovery index and intubation effect grade between the two groups ( P ＞ 0.05). Conclusion Diabetes can prolong the onset time of cisatracurium, but has no effect on the clinical duration and recovery time.     

腰麻—硬膜外联合阻滞与单纯硬膜外麻醉的临床比较观察

观察腰麻－硬膜外联合阻滞与单纯硬膜外麻醉的临床效果比较,方法：于下腹或下肢手术病人用腰－硬膜外联合阻并与单纯硬膜外麻醉进行临床比较观察。结果：应用联合阻滞针于一个间完成椎管内联合阻滞用于下腹上部位手安全有效的。