异氟醚对新斯的明拮抗维库溴铵肌松作用的影响

目的：研究一定浓度的异氟醚对新斯的明拮抗维库溴铵肌松作用的影响。方法：30例病人随机分为三组（各10例）：（1）丙泊酚静脉麻醉组,即对照组（P组）。（2）观察组。以异氟醚维持麻醉,再分为两组;术中呼气未异氟醚浓度均为1MAC,临近手术结束用新斯的明拮抗时,呼气末异氟醚浓度分别为1MAC（1M组（）和0．3MAC（0．3M组）,术中各组均连续输注维库溴铵,术毕以新斯的明0．035mg/kg拮抗并记录以下数据;维库溴铵输注速率,从拮抗开始到T1恢复到90％,TOF恢复到0．7和0．9的时间拮抗后15分钟时的T1,TOF比值,结果：1M组和0．3M组维库溴铵输注速率较P组降低IP＜0．05）,新斯的明拮抗后,0．3M组和1M组T1恢复到90％,TOF恢复到0．7和0．9的时间较P组延长（P＜0．05和P＜0．01）,1M组TOF恢复到0．9的时间较0＝3M组延长（P＜0．05）,在新斯的明拮抗后15分钟,0．3M组和1M组的T1和TOF比值均低于P组（P＜0．05）,1M组的TOF比值低于0．3M组（P＜0．05）,结论：呼气未浓度为1MAC和0．3MAC的异氟醚均能影响新斯的明对维库溴铵肌松作用的拮抗。     

新斯的明对维库溴铵肌松恢复的影响

研究表明新斯的明副作用与剂量有关，但其拮抗肌松作用具有一定的“饱和性”。此外，新斯的明给药时机的研究结果也存在争论。本试验拟采用维库溴铵在多次追加肌松药的情况下，观察新斯的明给药剂量和时间对肌松恢复的影响。     

小儿营养状态对维库溴铵肌松作用的影响

为了探讨肥胖或营养不良对小儿应用肌松药的影响,我们对33例不同营养状态的小儿使用维库溴铵进行肌松监测,现报告如下。     

不同吸入麻醉药对维库溴铵肌松作用的影响

本研究拟观察０．５ＭＡＣ的地氟醚、异氟醚、安氟醚对维库溴铵肌松作用的影响。资料与方法选择ＡＳＡⅠ～Ⅱ级五官科手术病人４０例，男２８例，女１２例，年龄１４～６５岁，体重４０～９０ｋｇ。术前肝、肾功能正常，无神经肌肉传递功能障碍性疾病，血电解质水平正常，近期内未用过影响神经肌肉功能的药物。四组病人术前３０分钟肌注阿托品０．５ｍｇ，静滴安定０．１～０．２ｍｇ·ｋｇ－１，哌替啶１～２ｍｇ·ｋｇ－１，氟哌利多０．０５～０．１ｍｇ·ｋｇ－１，用１％丁卡因对咽喉、气管粘膜表面麻醉，在镇痛健忘下经鼻或口腔行气管…     

异氟醚、地氟醚对维库溴铵残余肌松作用的影响

目的　观测异氟醚、地氟醚对维库溴铵的残余肌松作用的影响。方法　选择 4 9例ASAⅠ～Ⅱ级成年择期全麻手术病人 ,随机分为三组 :丙泊酚组 (Ⅰ组 ,18例 ) ;异氟醚组 (Ⅱ组 ,17例 ) ;地氟醚组 (Ⅲ组 ,14例 )。全麻诱导气管插管后维库溴铵均以 90 μg·kg-1·h-1的速度静脉泵入。Ⅰ组丙泊酚泵入速度为 4～ 10mg·kg-1·h-1;Ⅱ组、Ⅲ组分别吸入呼气末浓度为 1MAC的异氟醚或地氟醚 ,使用Biometer加速度仪观测T1恢复至 2 5 %、75 %及TOF比值 (T4/T1)恢复至 0 7的时间。结果　三组间病人的性别、年龄、体重、身高、芬太尼总量、麻醉持续时间、血液动力学变化均无显著性差异 (P >0 0 5 )。上述恢复时间 ,Ⅱ组、Ⅲ组与Ⅰ组比较均延长 ,有显著差异 (P <0 0 5 ) ;Ⅱ、Ⅲ组比较差别无统计学意义 (P >0 0 5 )。三组间恢复指数 (T1从 2 5 %～ 75 %时间 )比较无显著差异 (P >0 0 5 )。结论　异氟醚、地氟醚均可延长维库溴铵的残余肌松作用 ,但两者比较无明显差别。临床应用中应注意监测四个成串刺激 (TOF)等 ,减少术后残余肌松作用所致的并发症     

女性肥胖因素对维库溴铵肌松作用的影响

神经肌肉阻滞药是临床麻醉中的常用药 ,肥胖因素对一些神经肌肉阻滞药的影响已有报道[1 ] 。维库溴铵作为非去极化类中短效神经肌肉阻滞药 ,应用于临床已经很长时间。本文仅就女性成年病人肥胖因素对维库溴铵肌松作用的影响作一探讨。资料与方法一般资料　选择 30名女性病人 ,年龄 2 5～ 5 5岁 ,ASAⅠ～Ⅱ级。按体重指数 [bodymassindex ,BMI ,BMI =体重(kg) /身高 (m) 2 ]将病人分为三组 :Ⅰ组为对照组 (BMI 2 0～2 5kg/m2 ) ;Ⅱ组为超重组 (BMI 2 6～ 2 9kg/m2 ) ;Ⅲ组为肥胖组 (BMI大于 30kg/m2 )。所有病人心、肺功能均正常 ,无…     

国产维库溴铵临床肌松效应和安全性的评价

目的：估价国产维库溴铵在临床使用中的肌松效应和安全性，方法：多中心试验，择期手术病人２００例，随机分为国产维库溴铵组（１００例）和进口维库溴铵组（１００例）肌松监测标完成后，给予维库溴铵０．１ｍｇ／ｋｇ＋硫喷妥钠４～５ｍｇ／ｋｇ，麻醉维持用药为，安氟醚，氧化亚氮，芬太尼和氧气，肌松监测仪的“四个成串”刺激第一肌颤搐反应强度（Ｔ１）恢复至７５％时，试验结束。结果：静脉注射国产维为溴铵０．１ｍｇ／ｋｇ     

罗库溴铵 维库溴铵及美维松肌松效应的临床比较

目的比较罗库溴铵、维库溴铵及美维松的 肌松效应。方法45例ASAⅠ～Ⅱ级 全麻手术病人随机分为三组,各组分别于气管插管后注入相当于2倍ED     

维库溴铵用于肝功能损害病人残余肌松与呼吸功能恢复的研究

目的研究肝功能损害病人使用维库溴铵术后残余肌松及在肌松恢复不同程度下拔管后呼吸功能恢复的情况。方法60例择期手术病人,肝功能正常及轻度肝功能损害病人各30例,随机分为六组,每组10例。Ⅰ组：肝功能正常,根据临床征象判断拔管;Ⅱ组：肝功能正常,四个成串刺激率（TOFR）0．7拔管;Ⅲ组：肝功能正常,TOFR0．9拔管;Ⅳ组：肝功能损害,根据临床征象判断拔管;Ⅴ组：肝功能损害,TOFR0．7拔管;Ⅵ组：肝功能损害,TOFR0．9拔管。比较各组肌松恢复指标：末次给药至拔管时间、临床时效、恢复指数;术前和拔管后呼吸动力学参数：吸气潮气量（VT）、RR、分钟通气量（Ve）、自主呼吸做功（WOBp）、肺动态顺应性（Cdyn）、平均气道阻力（RAWm）、呼吸驱动力（P0．1）。结果Ⅰ组和Ⅳ组拔管时分别有5例和6例TOFR％0．7,Ⅳ、Ⅴ、Ⅵ组肌松恢复指标均较Ⅰ、Ⅱ、Ⅲ组延长。Ⅰ、Ⅳ组拔管后VTi、VE较术前减小,RR加快,P0．1、WOBp、RAWm增大,Cdyn减小（P％0．05或P％0．01）。Ⅱ、Ⅴ组仅WOBp较术前增大（P〈0．05）。Ⅲ、Ⅵ组拔管后呼吸动力学参数与术前相比差异无统计学意义。结论维库溴铵用于肝功能轻度损害病人术后肌松恢复时间延长,在未使用量化肌松监测的情况下根据临床征象判断拔管存在一定比例的残余肌松,同时多项呼吸动力学参数存在损害。而在肌松监测下TOFR0．7拔管,呼吸动力学参数基本能恢复至术前水平。     

Accelerated reversal of pancuronium blockade with divided administration of neostigmine

Key words  reversal of neuromuscular blockade pancuronium - neostigmine     

The influence of 0.5 % isoflurane on a vecuronium-induced neuromuscular blockade

The influence of adding 0.5% isoflurane to a narcotic-based anaesthesia on the duration of effect and recovery time after repetitive administration of vecuronium was studied in ten healthy patients. The twitch response in the adductor pollicis muscle was recorded after supramaximal train-of-four (TOF) stimulation of the ulnar nerve at the wrist. Prior to endotracheal intubation a bolus dose of vecuronium (0.08 mg/kg b.w.) was given. During surgery repeated injections of vecuronium (0.02 mg/kg b.w.) were administered at a TOF ratio of 0.25. Hand-skin temperature, systolic blood pressure, end-tidal CO2 and isoflurane concentrations were continuously monitored. Before and after 90 min administration of isoflurane, the duration of effect was 21 +/- 4 and 24 +/- 5 min (mean +/- s.d., P less than 0.05) respectively. Corresponding recovery times were 270 +/- 60 and 280 +/- 70 s (n.s.). Skin temperature remained unchanged and systolic blood pressure showed only minor variations. The addition of 0.5% isoflurane to a narcotic-based anaesthesia causes a moderate increase in duration of effect but no change in recovery time from a repetitive vecuronium-induced neuromuscular blockade of 0.02 mg/kg.     

新斯的明拮抗老年患者米库氯铵肌松残余的临床效果

目的观察新斯的明对老年患者应用米库氯铵术后肌松残余的影响。方法选择择期行全麻下腹腔镜下胃肠肿瘤切除手术的老年患者46例,男32例,女14例,年龄65~73岁,体重45~80kg,ASAⅠ或Ⅱ级。将患者随机分为两组,研究组(A组,n=22)术后给予拮抗药新斯的明20μg/kg,对照组(B组,n=24)给予等量生理盐水。采用四个成串刺激尺神经,通过拇内收肌的收缩反应以监测并记录术毕时(T_1)、拔管时(T_2)、拔管后5 min(T_3)、10 min(T_4)、30 min(T_5)时的TOFR(T4/T_1,T_1和T_4为第1和第4个颤搐反应高度)。统计拔管时Steward苏醒评分、Ramsay镇静评分及术后不良反应,并记录两组肌松恢复指标:临床时效(M1)(T_1恢复到25%的时间)、恢复指数(M2)(T_1从25%恢复到75%的时间)、TOFR恢复到0.7的时间(M3)、TOFR从0.7恢复到0.9的时间(M4)、停药至拔管时间(M5)。两组在麻醉诱导前和拔管时分别采集动脉血并检测血浆假性胆碱酯酶活性(D1和D2)。结果两组患者性别、年龄、身高、体重、BMI、手术时间、失血量、术毕体温、输液量、D1和D2、苏醒评分和镇静评分差异均无统计学意义。两组患者D1和D2的差值D与手术时间、输液量、失血量的相关性分析中,D与输液量明显相关(P0.05)。A组M1、M2、M3、M4和M5均明显小于B组(P0.05)。T3~T5时A组TOFR明显高于B组(P0.05)。T_3、T_4时A组TOFR0.7和T_4、T_5时A组TOFR0.9的发生率均低于B组(P0.05)。结论米库氯铵肌松恢复快,残余肌松相对较少,使用小剂量新斯的明拮抗使老年患者的麻醉恢复更加安全高效。     

术后非去极化肌松药肌松残余拮抗新进展

背景非去极化肌松药在临床麻醉中使用非常普遍,术后不可避免地发生肌松残余作用,其危害主要为呼吸不良事件,严重可导致死亡。 目的有效合理的肌松拮抗能降低术后肌松残余的发生率,减少相关并发症,因此,拮抗至关重要。内容阐述非去极化肌松药使用后手术结束时是否需要拮抗、拮抗的时机、拮抗剂的剂量和新的拮抗模式。趋向选择性肌松拮抗可...     

舒更葡糖钠对胸腹腔镜食管癌根治术患者术后肌松恢复的影响

目的 探讨舒更葡糖钠对全麻下胸腹腔镜食管癌根治术患者术后肌松恢复的影响.方法 选择全麻下行胸腹腔镜食管癌根治术患者96例,男61例,女35例,年龄18～65岁,ASAⅠ或Ⅱ级.采用随机数字表法将患者分为两组:新斯的明联合阿托品组(C组)和舒更葡糖钠组(S组),每组48例.两组麻醉诱导和术中全麻维持方案相同,使用四个成串...     

Effect of low-dose infusion of prostaglandin E1 on vecuronium-induced neuromuscular blockade

The effect of low-dose (20 ng·kg⁻¹·min⁻¹) infusion of prostaglandin E₁ (PGE₁) on vecuronium-induced neuromuscular blockade was studied. The study population consisted of 24 elderly patients (65–75 years old) and 24 younger adult patients (25–56 years old). They were randomly assigned to the control and PGE₁ groups. The steady-state dose requirement (SSDR) of vecuronium was derived from ondemand infusion of the drug which produced a stable twitch height of 20% of its baseline reading, and recovery time after steady-state infusion was defined as the time for recovery from twitch height from 25% to 75%. The patients in the PGE₁ group received an infusion of PGE₁ 20 ng·kg⁻¹·min⁻¹, while those in the control group received an infusion of normal saline. The SSDR (23.2±9.1 and 34.2±5.9 μg·kg⁻¹. hr⁻¹, respectively;P=0.02) was significantly less and the recovery time (35.0±9.5 and 19.9±4.2 min, respectively;P=0.01) was significantly longer in the elderly than in the younger patients. However, low-dose infusion of PGE₁ significantly increased the SSDR (23.2±9.1 to 37.4±3.7 μg· kg⁻¹·hr⁻¹;P=0.01) and shortened the recovery time (35.0±9.5 to 23.5±4.0 min;P=0.02) in elderly patients. We concluded that low-dose infusion of PGE₁ is effective in preventing the prolonged action of vecuronium in elderly patients.     

Prolonged mivacurium-induced neuromuscular blockade in patients with reduced plasma cholinesterase activity

Mivacurium is a recently released short-acting nondepolarizing muscle relaxant, metabolized by plasma cholinesterase. The short duration of action makes mivacurium an increasingly popular choice for muscle relaxation in ambulatory surgery procedures. Individuals with abnormalities of plasma cholinesterase, however, may have longer than expected duration of action of mivacurium, requiring prolonged mechanical ventilation. We present two cases where this occurred.     

A randomised controlled trial comparing deep neuromuscular blockade reversed with sugammadex with moderate neuromuscular block reversed with neostigmine

Deep neuromuscular block aims to improve operative conditions during laparoscopic surgery with a lower intra-abdominal pressure. Studies are conflicting on whether meaningful improvements in quality of recovery occur beyond emergence, and whether lower intra-abdominal pressure is achieved. In this pragmatic randomised trial with 1:1 allocation, adults undergoing elective laparoscopic surgery were allocated to moderate neuromuscular block reversed with neostigmine, or deep neuromuscular block reversed with sugammadex. Allocation was revealed to the anaesthetist only. Primary outcome was cognitive recovery of the Postoperative Quality of Recovery Scale, 7 days after surgery. Secondary outcomes included recovery in other domains of the Postoperative Quality of Recovery Scale at 15 min and 40 min; days 1, 3, 7, 14; and 1 and 3 months after surgery. Chi-square test was used for the primary outcome, and generalised linear mixed model for recovery over time between groups. Of 350 participants randomised, 140 (deep) and 144 (moderate) were analysed for the primary outcome. There was no difference in the Postoperative Quality of Recovery Scale cognitive domain at day 7 (deep 92.9% vs. moderate 91.8%, OR 1.164; 95%CI 0.486–2.788, p = 0.826), or at any other time-point. No significant difference was observed for physiological, emotive, activities of daily living, nociception, or overall recovery. Length of stay in the recovery area (mean (SD) deep 108 (58) vs. moderate 109 (57) min, p = 0.78) and hospital (1.8 (1.9) vs. 2.6 (3.5) days, p = 0.019) was not different. Intra-abdominal pressure and surgical operating conditions were not different between groups. Deep neuromuscular block did not improve quality of recovery compared with moderate neuromuscular block in operative laparoscopic surgery over a 1-h duration.     

Relationship between posttetanic count and response to carinal stimulation during vecuronium-induced neuromuscular blockade

The correlation between degree of peripheral neuromuscular blockade and response to carinal stimulation was evaluated in two groups of 25 patients: one group was anaesthetized with thiopental, N2O and halothane, and the other group received thiopental, N2O and fentanyl. The degree of peripheral blockade was evaluated using train-of-four (TOF) and posttetanic twitch (PTC) stimulation of the ulnar nerve. The degree of diaphragmatic paralysis was evaluated indirectly by stimulating the carina and observing the corresponding muscular response, which was graded as severe, mild or absent. During halothane anaesthesia a PTC of 0 always indicated that no response to carinal stimulation could be elicited. On the appearance of the first response to posttetanic twitch stimulation (PTC = 1), 2% of the patients showed a mild response to carinal stimulation. At the first response to TOF stimulation, 48% of the patients reacted with a mild response. During thiopental, N2O, fentanyl anaesthesia one of 25 patients showed a mild response to carinal stimulation at a PTC of 0. When PTC was 1, 20% of the patients reacted mildly to the stimulation. At the first response to TOF stimulation, 92% showed a response to carinal stimulation; 24% of these responses were severe, necessitating intervention. It is concluded that the TOF response elicited peripherally is a late sign of neuromuscular recovery of the diaphragm, and that the method of counting posttetanic twitches is superior to the TOF response in evaluating early recovery of this muscle. Further, to ensure total diaphragmatic paralysis, the neuromuscular blockade of the peripheral muscles should be so intense that no response to posttetanic twitch stimulation (PTC = 0) can be elicited.