新斯的明拮抗国产阿曲库铵效果及对Q-T离散度的影响

目的研究不同剂量新斯的明拮抗国产阿曲库铵肌松恢复作用的效果及对QT离散度(QTd)的影响.方法30例ASA Ⅰ～Ⅱ级患者,随机分为三组,每组10例.分别给予新斯的明20μg/kg(N20组)、30μg/kg(N30组)和40μg/kg(N40组),观察拮抗阿曲库铵肌松作用恢复时间及对QTd的影响.结果新斯的明20μg/kg产生的肌松恢复效果弱于30μg/kg和40μg/kg,而30 μg/kg和40μg/kg所产生的效果相似.新斯的明20 μg/kg、30μ/kg对QTd的影响不明显,而40μg/kg新斯的明明显增大QTd.结论新斯的明剂量由20μg/kg增加到40 μg/kg,肌松恢复加快,但增大QTd.     

术前口服美托洛尔对阿托品正性心率作用的影响

目的本研究探讨术前口服美托洛尔对丙泊酚麻醉时阿托品正性心率作用的影响。方法选择择期手术的全麻病人（ASAⅠ-Ⅱ）40例,随机分成两组,每组20例,第一组为实验组（M组）,术前口服美托洛尔50mg,第二组为对照组（C组）给予安慰剂;麻醉诱导后以5mg·kg^-1·h^-1的恒速灌注丙泊酚维持麻醉,待血流动力学稳定后静注阿托品,每次5μg/kg,每次静注间隔2min,记录病人心率变化,直至病人心率升高达20bpm,阿托品总量限制在30μg/kg。结果实验组病人阿托品用量5μg/kg对心率没有明显变化,10μg/kg升高6bpm±5bpm;对照组用量在5μg/kg和10μg/kg,心率分别升高3bpm±5bpm和12bpm±6bpm,不同剂量组间差异存在统计学意义（P〈0．05）。阿托品用量达到15μg/kg,对照组63％病人心率升高达到20bpm,实验组21％病人心率升高达到20bpm,组间差异存在统计学意义（P〈0．05）。阿托品剂量达到30μg/kg,对照组90％和实验组79％病人心率升高达到20bpm,组间没有统计学差异（P〉0．05）。结论术前口服美托洛尔50mg减弱阿托品正性心率作用,该作用能够被大剂量阿托品有效逆转。     

用前列腺素E_1进行低血压麻醉的研究

作者在麻醉时注用前列腺素 E_1(PEG_1)0.1～0.3μg/kg/分和0.4μg/kg/分以上降低血压观察血流动力学的影响,并用激光多普勤速度计法和深部体温测定法观察低血压时的末梢循环、尿量以及出血量的变化。作者选择28例乳房切除术病人(ASA Ⅰ～Ⅱ级)分成3组:Ps 组9例注用 PGE_1 0.1～0.3μg/kg/min;PL 组10例注 PGE_1 0.4μg/kg/min～0.7μg/kg/min;TMP 组9例注阿方那特(trimethaphan)7.5—35.5μg/kg/min。全部28例病人均静注硫喷妥纳诱导,吸入安氟     

芬太尼同新芬太尼麻醉的回顾;多少剂量能满足

本文研究芬太尼同新芬太尼抑制血液动力学和手术刺激激素的反应有关剂量,选择冠状动脉搭挢80位病人分两组连贯记录,第一组随机双盲试验,40位病人接受一次剂量芬太尼(50或100μg/kg)或新芬太尼(10,20或30μg/kg)测血液动力学同激素浓度(肾素,醛固酮,可地松同儿茶酚胺),分别于诱导,插管,开胸前后。第二组40位病人任意随机选用其中一组接受新芬太尼4种剂量,(1)单次剂量30μg/kg,(2)10μg/kg,(3)0.05μg/kg/min,(4)20μg/kg/min,测量血液动力学及血浆新芬太尼与儿茶酚胺浓度,分别于诱导前后,插管后,开胸及动脉插管,按记录规定血液动力学反应15％或以上增加收缩压(SBP)同激素对照值增加50％或以上,在一组18位病人有血液动力学反应(平均增加SBP22.6±2％),35位患者中59次有     

氯化钙与肾上腺素在体外循环后的心肌支持作用

本文研究氯化钙与肾上腺素在体外循环后的心肌支持作用及钙对肾上腺素心肌支持作用的影响.方法:40例术前左心功能正常行冠状动脉旁路术病人,在大剂量芬太尼(50～100μg/kg)或苏芬太尼(10～30μg/kg)麻醉、中低温体外循环及高钾停跳液心肌保护下进行手术.于心脏复跳、完全复温、停体外循环后进行本研究.40例病人随机分为氯化钙组和安慰剂组各20例,分别静注氯化钙5mg/kg或安慰剂(生理盐水);用药后6min,再随机将病人分为肾上腺素组和安慰剂组各20例,即使病人分为四组:安慰剂+安慰剂组,安慰剂+肾上腺素组,氯化钙+肾上腺素组,氯化钙+安慰剂组各10例,分别静滴30ng·kg~(-1)·min~(-1)的肾     

大剂量芬太尼用于心脏手术期间脑功能和意识状态

临床上很少从事人脑氧耗的监测研究。本实验是在静脉芬太尼麻醉下心脏手术病人中研究意识状态与大脑氧的供/需比例关系。作者将病人分成两组,其中26例病人给芬太尼25μg/kg,另24例病人一次静脉推注50μg/kg。全部病人都吸纯氧,诱导期间只给芬太尼麻醉。为保证肌肉松弛,在给芬太尼前先静脉内注射12mg本可松。当芬太尼诱导剂量药效渐渐减弱,接着按每分钟0.5μg/kg     

芬太尼预先给药用于快速麻醉诱导

快速诱导喉镜操作和气管插管所产生的应激反应加重了心血管的负担。即使一般病人也可发生高血压,心动过速和心律失常,而冠心病患者的危险性则更高。作者以血流动力学和神经内分泌指数为指标,观察在快速诱导中预先用小剂量芬太尼(5μg/kg)减少应激反应的情况。本研究选30例择期手术病人,年龄40～65岁,不给术前药。将病人随机分成芬太尼组或对照组。两组的年龄、体重、身高、性别、体格状况、高血压史及吸烟史差别不大。先测量病人的血压、心率、血中β-内啡肽及儿茶酚胺浓度作为基础值。1分钟后开始给氧去氮,并由静脉给予筒箭毒硷3mg。芬太尼组在4分钟内接受芬太尼1μg/kg/min,然后用硫喷妥钠2mg/kg、芬太尼1μg/kg(总量为5μg/kg)、琥珀胆碱1.5mg/kg进行快速诱导。对照组诱导用硫喷妥钠4mg/kg、琥珀胆碱1.5mg/kg。全部病人于诱导后1分钟气管内插管,给予     

依托咪酯乳剂与异丙酚乳剂用于全麻诱导的比较

本文将依托咪酯乳剂宜妥利与异丙酚乳剂得普利麻在全麻诱导中应用进行了对比观察。资料与方法 30例择期手术拟行全麻的病人随机分为异丙酚组与依托咪酯组。两组病人一般情况无差别。芬太尼2μg/kg静注2分后,两组分别以依托咪酯0.3mg/kg、异丙酚2mg/kg诱导。0.1mg/kg维库溴铵辅助插管,机械通气。N_2O、氧气、安氟醚吸入,芬太尼2μg·kg~(-1)·h~(-1)持续静注维持麻醉。记录注药时间、诱     

缺血性心脏病人麻醉诱导和纵断胸骨期间的左室功能

作者给缺血性心脏病病人分别使用6种不同的麻醉方法分析比较麻醉诱导和纵断胸骨期间的左室功能(LVF)变化。作者选择47例冠脉搭桥术病人(仅4名女姓),术前射血分数均在55％以上,长期使用β-阻断药、硝酸甘油和硝苯吡啶直到术前48小时。随机分成6组(每组7～10例):FE组(芬太尼总量30μg/kg);HAL组(静注硫贲妥钠6 mg/kg后用1％氟烷维持);MO组(吗啡2mg/kg);NLA组(芬太尼15μg/kg加氟哌啶0.3mg/kg);PE_3组(硫贲妥钠     

不同剂量布托啡诺静注对病人呼吸功能和镇静程度的影响

目的研究静脉注射不同剂量布托啡诺对病人呼吸功能和镇静程度的影响。方法选择择期手术病人45例,ASAⅠ或Ⅱ级,年龄20~55岁,体重50~80kg,随机分成三组(n=15),麻醉前静注布托啡诺10μg/kg(Ⅰ组)、20μg/kg(Ⅱ组)、30μg/kg(Ⅲ组)。观察给药前(基础值)(T0)、给药后1min(T1)、3min(T2)、5min(T3)、7min(T4)、10min(T5)、15min(T6)、20min(T7)、30min(T8)各时点的潮气量(VT)、RR、SpO2、PETCO2、分钟通气量(MV)、HR、MAP等呼吸循环参数及BIS和镇静/警觉(OAA/S)评分。结果Ⅰ组、Ⅱ组RR、VT、MV各时点数值在注药后略有降低,Ⅲ组则在T1~T4时明显低于T0时(P<0.05)(RR降低24.3%~28.2%,VT降低22.1%~31.0%,MV降低31.1%~48.5%);PETCO2和SpO2各组均在正常范围内波动;Ⅰ组、Ⅱ组BIS变化不显著;Ⅲ组在T2~T8时BIS降低9.7%~14.5%(P<0.01),相应的OAA/S评分也明显下降(P<0.05)。结论小剂量布托啡诺(10~30μg/kg)静注是安全的。当剂量达到30μg/kg时对病人呼吸功能有轻度抑制作用(持续时间≤7min),同时BIS值下降,显示有轻度镇静作用。     

Cisatracurium or rocuronium versus rocuronium-cisatracurium combination

The present report evaluates the incidence of pain on intravenous injection and the condition of tracheal intubation at one minute following the administration of cisatracurium or rocuronium versus rocuronium-cisatracurium combination. We studied 60 patients, ASA 1, aged 18-60 years, undergoing elective surgical procedures. The patients were randomly assigned to 3 groups who received intravenously either 0.15 mg/kg cisatracurium [2ED95], 0,6 mg rocuronium [2ED95] or a combination of 0.075 mg/kg cisatracurium [1ED95], plus 0.3 mg rocuronium [1ED95]. In the awake patients, the pain on injection of muscle relaxant was assessed on a four point scale (none, mild, moderate, severe). Administration of the relaxant was followed by 1-2 mg/kg of lidocaine and 2 mg/kg propofol. Orotracheal intubation was performed 60 seconds following the administration of the relaxant. The intubating conditions were assessed and rated as excellent, good, fair or poor. The administration of 2ED95 cisatracurium resulted in poor intubating conditions at 60s, without pain on injection. In contrast, the administration of 2ED95 rocuronium resulted in excellent or good intubating conditions at 60s associated with high incidence of pain on injection in most of the patients. However, the combination of 1ED95 cisatracurium with 1ED95 rocuronium provided similar intubating conditions to the 2ED95 rocuronium alone, associated with a significantly less pain on injection.     

Comparison of the neuromuscular blocking effect of cisatracurium and atracurium on the larynx and the adductor pollicis

BACKGROUND: Cisatracurium unlike atracurium is devoid of histamine-induced cardiovascular effects and this alone would be the greatest advantage in replacing atracurium for the facilitation of tracheal intubation. On the other hand, 2 ED(95) doses of cisatracurium (100 micro g/kg) do not yield satisfactory intubating conditions such as those seen with equipotent doses of atracurium and therefore the recommended intubating dose of cisatracurium is 3 ED(95). To understand this discrepancy better, we evaluated the potency and onset of atracurium and cisatracurium directly at the larynx adductors in humans. METHODS: The study was conducted in 54 patients (ASA class I or II) undergoing peripheral surgery requiring general anesthesia. Cisatracurium 25-150 micro g/kg or atracurium 120-500 micro g/kg intravenous (i.v.) boluses doses were administered during anesthesia with propofol, nitrous oxide, oxygen and fentanyl. Neuromuscular block was measured by electromyography (single twitch stimulation every 10 s) at the larynx and the adductor pollicis. The dose-response effect measured at both muscles included maximum neuromuscular blockade achieved (Emax), the time to maximum depression of twitch height (onset) and time to spontaneous recovery of the twitch height to 25%, 75% and 90% (T25, T75, T90) of control value. RESULT: The onset at the larynx was of 196 +/- 28 s after the 100 micro g/kg cisatracurium dose compared with 140 +/- 14 s after the 500 micro g/kg atracurium dose (P < 0.05). Emax at the larynx was 92 +/- 1% and 98 +/- 1% after 100 micro g/kg cisatracurium and 500 micro g/kg atracurium, respectively (P < 0.05). The time to onset of maximum suppression Emax = 100 +/- 0% after a 150 micro g/kg cisatracurium dose was 148 +/- 29 s. At the larynx, the ED(50) was 25 micro g/kg for cisatracurium and 180 micro g/kg for atracurium and the ED(95) was 87 micro g/kg for cisatracurium compared with 400 micro g/kg for atracurium. CONCLUSION: The slow onset time at the laryngeal muscles after cisatracurium can be explained by the higher potency as compared with atracurium.     

不同性别患者预注顺阿曲库铵加快起效的半数有效剂量

目的 探讨不同性别患者预注顺阿曲库铵加快起效的半数有效剂量(ED50).方法 择期拟在全身麻醉下行腹部手术的患者90例,年龄18～55岁,分为2组(n=45):男性组(M组)和女性组(F组).采用TOF-Watch SX型加速度肌松监测仪对尺神经行单次颤搐刺激,监测拇内收肌肌颤搐情况.静脉注射咪达唑仑0.04 mg/kg、芬太尼1 μg/kg,患者意识消失后开启加速度肌松监测仪,静脉注射顺阿曲库铵预注剂量,3 min后静脉注射芬太尼5 μg/kg、异丙酚2 mg/kg,静脉注射预注量后4 min,静脉注射顺阿曲库铵剩余插管剂量(3×ED95即0.15 mg/kg减去预注量),当单刺激颤搐值与对照值的比值下降至10%,行气管插管.静脉输注异丙酚、瑞芬太尼,吸入异氟烷维持麻醉.预注量根据序贯法确定,预注量从5μg/kg(10%ED95)开始,各相邻剂量比值为1.2.记录给予预注量后4min时单刺激颤搐值与对照值的比值、90%起效时间、起效时间、最大阻滞程度、临床作用时间.计算预注顺阿曲库铵加快起效的ED50及其95%可信区间(CI).结果 M组90%起效时间长于F组(P＜0.05),其余肌松效应指标两组比较差异无统计学意义(P＞0.05).预注顺阿曲库铵加快起效的ED50:男性为21.36μg/kg,95%CI为20.52～22.23μg/kg;女性为14.53 μg/kg,95%CI为13.77～15.33μg/kg,男性高于女性(P＜0.05).结论 预注顺阿曲库铵加快起效的ED50:男性为21.36μg/kg,女性为14.53 μg/kg,男性高于女性.     

芬太尼抑制七氟醚复合瑞芬太尼麻醉恢复期间患儿躁动的药效学

目的 探讨芬太尼抑制七氟醚复合瑞芬太尼麻醉恢复期间患儿躁动的药效学.方法 择期拟行鼻内镜下增殖体刮除术的息儿26例,年龄5～8岁,体重15～30 kg,ASA Ⅰ或Ⅱ级.麻醉诱导:吸入8%七氟醚(氧流量6 L/min),静脉注射瑞芬太尼1 μg/kg(经30 s注射完),气管插管后行机械通气,随后静脉注射芬太尼抑制麻醉恢复期间患儿躁动,采用改良的序贯法确定静脉注射芬太尼的剂量.第1例患儿静脉注射芬太尼的剂量为4μg/kg,相邻剂量差值为0.5μg/kg,以患儿苏醒后易激惹且难以安慰作为判断躁动发生的标准.麻醉维持:吸人2%七氟醚(氧流量1 L/min),静脉输注瑞芬太尼0.2μg·kg-1·min-1.术毕停用七氟醚和瑞芬太尼,带气管导管回麻醉恢复室,待患儿苏醒.记录术后4h内患儿躁动、恶心、呕吐、呼吸抑制等的发生情况及苏醒时间.计算芬太尼抑制50%、95%患儿七氟醚复合瑞芬太尼麻醉恢复期间躁动的剂量(ED50、ED95)及其95%可信区间.结果 芬太尼抑制七氟醚复合瑞芬太尼麻醉恢复期间患儿躁动的ED50及其95%可信区间为3.01(2.52～3.40)μg/kg,En95及其95%可信区间为3.81(3.41～6.22)μg/kg.术后4h内未发生明显恶心、呕吐及呼吸抑制.苏醒时间(11.3±2.6)min.结论 芬太尼抑制七氟醚复合瑞芬太尼麻醉恢复期间患儿躁动的ED50为3.01μg/kg,ED95为3.81μg/kg.     

小儿气管内插管时舒芬太尼静注的ED50与ED95

目的测定七氟醚全麻诱导时舒芬太尼为小儿提供满意气管内插管条件的ED50与ED95。方法选择2～8岁择期行气管内插管全麻患儿100例,ASAⅠ级,随机均分为五组,七氟醚诱导后分别给予不同剂量舒芬太尼0.1μg/kg(S1组)、0.2μg/kg(S2组)、0.3μg/kg(S3组)、0.4μg/kg(S4组)、0.5μg/kg(S5组)行气管内插管。同时记录插管前1min(T1)、插管即刻(T2)、插管后1min(T3)、3min(T4)、5min(T5)、10min(T6)BP、HR及Narcotrend麻醉深度数值变化。在Viby-Mogensen气管内插管条件评价法评价气管内插管条件基础上使用概率单位分析法计算舒芬太尼为小儿提供满意气管内插管的ED50及ED95。结果在七氟醚呼气末浓度3%,Viby-Mogensen气管内插管条件评价为"优秀"时,结合患儿气管内插管心血管反应阴性作为满意气管内插管条件,舒芬太尼为小儿提供满意气管内插管的ED50为0.305μg/kg[95%可信区间(CI)为0.239～0.354μg/kg],ED95为0.598μg/kg(95%CI为0.484～1.019μg/kg)。结论在七氟醚呼气末浓度3%时,小儿气管内插管舒芬太尼静注ED50与ED95分别为0.305μg/kg和0.598μg/kg。     

癫痫患者顺式阿曲库铵的剂量反应曲线测定

目的 采用单次剂量注射法建立癫痫患者顺式阿曲库铵的剂量反应曲线,确定其量效关系及ED95,为癫痫患者合理应用顺式阿曲库铵提供依据.方法 选取择期癫痫手术患者40例,ASA Ⅰ～Ⅱ级,年龄16岁～42岁,病史3年～26年,均具有服用抗癫痫药物史,术前无酸碱平衡及水电解质紊乱,心肺、肝肾功能正常.患者按随机数字法分为20μ...     

A comparison of the onset and clinical duration of high doses of cisatracurium and rocuronium.

STUDY OBJECTIVE: To determine the onset and clinical duration of cisatracurium and rocuronium in equipotent doses in balanced opioid/isoflurane anesthesia. DESIGN: Randomized, controlled study. SETTING: University hospital. PATIENTS: 40 healthy patients scheduled for elective surgery. INTERVENTIONS: Patients underwent anesthesia induction with thiopental or propofol with a cisatracurium intubating dose of either 0.15 or 0.2 mg/kg or a rocuronium dose of either 0.9 or 1.2 mg/kg. These doses correspond to three and four times the ED95 dose. MEASUREMENTS AND MAIN RESULTS: The onset time and time to 25% recovery of baseline first twitch in a train-of-four were determined using an accelerometric sensor. Rocuronium had a faster onset time that cisatracurium at equipotent doses (3 x ED95: 134 vs. 220 sec respectively, and at 4 x ED95: 95 vs. 162 sec). Recovery tended to be faster, but not statistically different for cisatracurium compared to rocuronium. CONCLUSIONS: With equipotent intubating doses of rocuronium and cisatracurium, rocuronium produces a more rapid onset of muscle relaxation. The data suggest a tendency toward more rapid clinical recovery of cisatracurium compared to equipotent doses of rocuronium, although these differences were not statistically significant.     

恶性肿瘤对顺阿曲库铵肌松效应的影响

目的 探讨恶性肿瘤对顺阿曲库铵肌松效应的影响.方法 选择头颈部肿瘤患者60例,ASA分级Ⅰ或Ⅱ级,年龄18～64岁,分为4组(n=15),良性肿瘤组(B组,3×ED95);45例恶性肿瘤患者按顺阿曲库铵使用剂量分为C1组(2×ED95)、C2组(3×ED95)和C3组(4 × E95).采用TOF-Watch SX型加速度肌松监测仪对尺神经行单次颤搐刺激,监测拇内收肌颤搐情况.麻醉诱导:靶控输注异丙酚(血浆靶浓度3μg//ml)和瑞芬太尼(效应室靶浓度3 ng/ml),患者意识消失后开启加速度肌松监测仪.B组静脉注射顺阿曲库铵0.15 mg/kg行气管插管.C1组、C2组和C3组分别静脉注射顺阿曲库铵0.10、0.15和0.20mg/kg行气管插管.记录顺阿曲库铵起效时间,临床作用时间、T/Tc恢复至75%的时间及其恢复指数.结果 与B组比较,C2组顺阿曲库铵临床作用时间、T/Tc恢复至75%的时间及恢复指数延长(P＜0.05),起效时间差异无统计学意义(P＞0.05).与C1组比较,C2组和C3组顺阿曲库铵起效时间缩短,临床作用时间、T/Tc恢复至75%的时间延长(P＜0.05),恢复指数差异无统计学意义(P＞0.05).与C2组比较,C3组顺阿曲库铵起效时间缩短,临床作用时间、T/Tc恢复至75%时间延长(P＜0.05),恢复指数差异无统计学意义(P＞0.05).结论 恶性肿瘤患者应用顺阿曲库铵肌松效应的维持和恢复时间延长.     

终末期肾病患者顺式阿曲库铵量效关系测定

目的采用单次剂量注射法测定终末期肾病患者顺式阿曲库铵量效关系。方法选取接受肾移植的终末期肾病患者40例,按完全随机方法分为4组,每组10例,对4个剂量组患者按体重注射20、30、40、50μg／kg的顺式阿曲库铵。选取无神经肌肉病变的患者20例作为对照组,给予相同剂量的苯磺酸顺式阿曲库铵。记录每个患者最大抑制效应,并对最大抑制效应进行概率转换,对应的肌松药剂量进行对数转换,用直线回归方法建立顺式阿曲库铵的剂量-反应曲线。结果终末期肾病患者顺式阿曲库铵50％有效剂量（ED50）、75％有效剂量（ED75）、90％有效剂量（ED90）、95％有效剂量ED95分别为30．88、35．65、40．62、43．85μg/kg,无神经肌肉病变患者顺式阿曲库铵ED。ED。ED。ED。分别为35．37、42．22、49．60、54．55μg/kg,终末期肾病患者顺式阿曲库铵ED。明显低于无神经肌肉病变患者ED95（P〈0．01）。结论终末期肾病患者因周围神经病变累及神经肌肉接头可导致对肌松药的敏感性增加。     

Die klinische Pharmakologie von Cisatracurium

Cisatracurium (51W89) is one of the ten stereoisomers of atracurium, accounting for about 15% of the racemate. The ED₉₅ of cisatracurium was determined to be about 50?μg/kg (cation, molecular weight 929), while the ED₉₅ of atracurium (besylate salt, molecular weight 1245) was 250?μg/kg. Thus, on a molar basis in adult patients, cisatracurium is about 3.5 times as potent as the racemic atracurium mixture. We compared atracurium with cisatracurium in healthy adult patients and found an almost identical pharmacodynamic profile. In children, an ED₉₅ of about 40?μg/kg was determined, while a 1-min-longer onset of cisatracurium was found in geriatric than in young adult patients. The presence of chronic renal failure did not prolong the duration of action of cisatracurium. The recovery of neuromuscular transmission from a cisatracurium infusion of up to 145?h was investigated in intensive care unit patients. Their time from the end of infusion to a train-of-four ratio >0.7 (68±18?min) was on average only some 70% longer than after an infusion of cisatracurium for 2?h in normal surgical patients. In another study, no signs of histamine release nor any clinically relevant cardiovascular effects of cisatracurium were found in doses up to eight times ED₉₅.