七氟醚呼气末浓度对新斯的明拮抗罗库溴铵肌松作用的影响

目的研究七氟醚呼气末浓度对新斯的明拮抗罗库溴铵肌松作用的影响。方法48例择期行颌面部全麻手术病人随机分成四组：异丙酚、瑞芬太尼麻醉维持组（P组异丙酚输注速度2~5μg.kg-1.min-1）,0.4MAC七氟醚、瑞芬太尼麻醉维持组（S-1组,维持七氟醚呼气末体积浓度0.7%）、0.7MAC七氟醚、瑞芬太尼麻醉维持组（S-2组,维持七氟醚呼气末体积浓度1.0%）和1.0MAC七氟醚、瑞芬太尼麻醉维持组（S-3组,维持七氟醚呼气末体积浓度1.7%）,首量2倍ED95罗库溴铵保持肌松。当TOF的T1恢复到25%时,给予新斯的明0.04 mg.kg-1.min-1。记录T1和TOFr恢复过程。结果给予新斯的明后S-2组和S-3组的T1恢复时程基本相似,但恢复时间均明显比S-1组长。而S-1组T1恢复到50%、75%、95%和100%的时间和P组基本相同。结论0.4MAC七氟醚对罗库溴铵肌松效应无明显影响。0.7MAC七氟醚能增强罗库溴铵的肌松效应,影响程度与1MAC七氟醚相似,延迟新斯的明拮抗罗库溴铵肌松作用的时间。

Impact of end - tidal concentration of sevoflurane on neostigmine antagonism of rocunium-induced muscle relaxation

Objective ： To study the influence of end-tidal concentration of sevoflurane on neostigmine antagonism of rocuniumn-induced neuromusclecular block. Methods： Forty-eight patients undergoing selective surgeries were randomized into four groups. After intravenous midazoline 0.15 mg · kg^-1 and fentanyl 4μg·kg^-1, anesthesia maitainance was achieved by sevoflurane inhalation end-tidal concention 0.7 Vol% in group S-1 （n = 12） , 1.0 Vol% in group S-2（ n = 12） and 1.7 Vol% in group S-3（ n = 12） while the control group was maintained by infusion propoful （ 2 - 5 μg·kg^-1·min^-1 ） in group P（ n = 12 ） , respectively. In all groups neuromusclecular was induced by rocuronium and monitored by using train-of-four （TOF） stimulation ulnar nerve. When the first response in TOF （Tl ） recovered to 25% , neosigmine was given. The time points of T1 ,50% , 75% ,95% , 100% recovery and TOFr 0.75 were recorded. Results ： There were no significant differences beteen group S-I and group P with respect to T1 recovery time （P 〉 0.05 ）. The time length of T1 recovering to 50% , 75% ,95% , 100% in group S-2 and S-3 were apparently longer those in group S-1 and group P. While those in group S-2 were similar to those in group in S-3. Conclusion ： Inhalation sevoflance 0. 7MAC significantly enhances neuromuscular block and delays the onset of neosgimine as an antagonist of rocuronium, but there is no significant difference between 0.4 MAC sevoflurane and propoful.