紫绀及非紫绀型先天性心脏病患儿罗库溴铵药效学的比较

目的 比较紫绀及非紫绀型先天性心脏病(先心病)患儿罗库溴铵的药效学。方法 第一部分:选择非紫绀、轻度紫绀及重度紫绀型先心病患儿各12例,分别为非紫绀组、轻度紫绀组、重度紫绀组,测定0.6 mg／kg罗库溴铵的起效时间、作用时间及恢复指数。第二部分:40例先心病患儿,选择非紫绀、紫绀型先心病患儿各20例,分别为非紫绀组和紫绀组,每组患儿随机分为120、180、240、300μg／kg四个剂量组,用直线回归法建立罗库溴铵的量效曲线,计算罗库溴铵的ED50、ED90,及ED95。结果 第一部分:重度紫绀组起效时间较非紫绀组明显延长(P<0.05),三组间作用时间及恢复指数无差异。第二部分:紫绀组罗库溴铵的量效关系曲线较非紫绀组右移,紫绀组罗库溴铵ED50、ED90及ED95均较非紫绀组高(P<0.05)。结论 重度紫绀型先心病患儿罗库溴铵的起效时间延长,且对罗库溴铵的敏感性降低。     

罗库溴铵用于婴儿骨科手术的临床效果

目的观察罗库溴铵用于婴儿骨科手术的药效学和临床效果。方法 80例择期全麻骨科手术患儿,年龄1~12月。研究分为两部分:(1)量效关系测定:40例婴儿随机分为L1、L2、L3、L4组,建立罗库溴铵量-效关系曲线,计算ED50和ED95。(2)肌松时效观察:其余40例随机给予1倍ED95(L5组)、1.5倍ED95(L6组)、2倍ED95(L7组)、3倍ED95(L8组)罗库溴铵,记录插管条件、起效时间、恢复时间、恢复指数。结果婴儿罗库溴铵ED50为175.14μg/kg,95%可信区间(CI)69.96~533.62μg/kg;ED95为232.31μg/kg,95%CI 90.42~728.62μg/kg。随着罗库溴铵剂量的增大,L6组、L7组、L8组起效时间明显短于L5组(P0.05或P0.01),肌颤搐恢复时间明显长于L5组(P0.05);L7组和L8组恢复指数明显慢于L5组和L6组(P0.05或P0.01)。结论 1.5倍ED95即350μg/kg罗库溴铵即能够提供婴儿良好的气管插管条件,适用于手术时间短而又需要全麻插管的手术。     

癫痫患者罗库溴铵95％有效量的测定

目的 通过测定癫痫患者罗库溴铵95％有效量(95％ effective dose,ED95),为癫痫患者合理应用罗库溴铵提供依据. 方法 选取择期行癫痫病灶切除术患者40例,ASA分级Ⅰ、Ⅱ级.根据罗库溴铵不同剂量按随机数字表法分为4组(每组10例):120 μg/kg组、180 μg/kg组、240 μg/kg组和300 μg/kg组.采用单次剂量注射法测定患者ED95,记录拇指内收肌“四个成串刺激(train of four stimulation,TOF)”第1个肌颤搐反应(T1)最大抑制的百分比及药物的起效时间,将最大抑制百分比进行概率单位转换,罗库溴铵的首次剂量做对数转换,用直线回归方法建立维库溴铵的剂量-反应曲线,计算出癫痫患者的罗库溴铵ED95值. 结果 各组间一般情况比较,差异无统计学意义(P＞0.05);不同剂量组起效时间比较,差异无统计学意义(P＞0.05),T1最大抑制程度随剂量增加而增加(P＜0.05),但240 μg/kg组和300 μg/kg组间差异无统计学意义(P＞0.05);癫痫患者罗库溴铵ED95值为445.3 μg/kg,高于目前正常人群广泛应用的ED95值300 μg/kg(P＜0.05). 结论 癫痫患者罗库溴铵的ED95值高于正常人群,在该类患者中应增加罗库溴铵的剂量约50％以取得与正常人群相同的肌松水平.     

丙泊酚对罗库溴铵有效剂量的影响

目的 比较丙泊酚不同输注时间对罗库溴铵有效剂量的影响.方法 中青年女性全麻手术患者24例,以血浆靶浓度4 μg/ml输注丙泊酚和静注雷米芬太尼1/μg/kg麻醉诱导,气管内插管.输注丙泊酚和雷米芬太尼维持脑电双频指数40～50.监测拇内收肌颤搐反应.持续输注丙泊酚5 min(Ⅰ组)或20 min(Ⅱ组)后,给予首剂量罗席溴铵150 μg/kg.当TOF的T1下降并稳定在同一高度时,静注罗库溴铵50 μg/kg,直到T1抑制程度超过90%.记录每次静脉注射罗库溴铵后T1稳定值、间隔时间和皮温测定值,观察有无不良反应.结果 Ⅰ组罗席溴铵ED90和ED95分别为(261.6士53.8)μg/kg和(321.9±73.9)μg/kg,略高于Ⅱ组的(235.3±46.9)μg/kg和(297.7士53.5)μg/kg.两组罗库溴铵量效关系曲线的斜率和截距差异均无统计学意义.结论 中青年女性患者输注丙泊酚对罗库溴铵有效剂量无明显影响.     

罗库溴铵和阿曲库铵联合应用的肌松效应分析

目的探讨罗库溴铵和阿曲库铵联合应用时的肌松效应。方法择期全麻手术女性成年患者147例,丙泊酚和舒芬太尼静脉诱导,输注丙泊酚维持麻醉。面罩辅助或控制呼吸,用加速度仪以连续4次刺激(TOF)方式透皮刺激腕部尺神经,获取肌松药作用起效时间和T1最大抑制程度(Tmax)。按观测项目将患者均分成四组。结果阿曲溴铵ED95为(220.8±3.6)μg/kg,罗库溴铵ED95为(286.3±3.1)μg/kg。0.5×ED95的罗库溴铵与阿曲库铵联合使用,肌松效应达到T1抑制93%~97%时,阿曲库铵的剂量为63.6μg/kg。罗库溴铵0.5×ED95与阿曲库铵63.6μg/kg联合使用,Tmax为(95.3±0.9)%,变异系数1.0%。Ⅳ组中三个亚组的Tmax基本相同,合用组作用起效时间比阿曲库铵组快(P<0.01)。给予肌松药前和注药后5min内,MAP和HR的波动幅度均小于5%。结论罗库溴铵与阿曲库铵合用呈协同作用。当罗库溴铵剂量为0.5×ED95时,为获得T1抑制95%的肌松效应,阿曲库铵的合理用量为63.6μg/kg,比阿曲库铵的ED95减少71.2%。     

罗库溴铵用于老年人的有效剂量探讨

目的　用单次剂量法评估罗库溴铵在老年人和中年人剂量反应的差异 ,并探讨其可能的机制。方法　择期全麻手术患者 80例 ,分成中青年组 (30～ 4 5岁 )和老年组 (>6 5岁 ) ,每组 4 0例。按罗库溴铵用量将老年组再分成 10 0、15 0、2 0 0、2 5 0和 2 75 μg/kg五个亚组 ,中青年组分为 10 0、15 0、2 0 0、2 5 0和 30 0 μg/kg五个亚组 ,每亚组 8例。丙泊酚和芬太尼诱导及手控气囊面罩通气下 ,用加速度仪以连续 4次刺激方式刺激尺神经 ,获取静脉注射罗库溴铵后T1最大抑制 (Tmax)程度和时间。结果　老年组罗库溴铵的ED50 、ED90 和ED95分别为 (115 0 8± 35 10 ) μg/kg、(2 4 7 4 4± 32 95 )μg/kg和 (2 6 3 10± 34 15 ) μg/kg ,中青年组分别为 (15 0 5 0± 2 9 2 8) μg/kg、(2 74 0 4± 30 6 3) μg/kg和 (2 89 4 9± 31 70 ) μg/kg。老年组的ED50 、ED90 及ED95分别是中青年组的 76 %、90 3%和 91 2 %(P <0 0 1)。老年组的血清钾、血浆总蛋白和白蛋白浓度低于中青年组 (P <0 0 5 )。结论　罗库溴铵在正常体重老年人的作用强度大于中青年。年龄组间罗库溴铵作用强度的差异可能与电解质和血浆蛋白水平的差异有关     

癫痫患者维库溴铵ED95的测定

目的 测定癫痫患者维库溴铵ED(95)值.方法 选取择期癫痫手术患者50例,ASA Ⅰ或Ⅱ级,年龄16～43岁,病史3～26年.患者均有服用抗癫痫药物史,术前均无酸碱平衡及水电解质紊乱,心肺、肝肾功能正常,随机均分为5个剂量组,维库溴铵剂量分别为20、30、40、50、60 μg/kg.记录拇内收肌四个成串刺激第一次反应最大抑制的百分率并进行概率单位转换,将维库溴铵的首次剂量进行对数转换,用直线回归方法建立维库溴铵的剂量-反应曲线,并记录起效时间.结果 癫痫患者维库溴铵ED(95)为57.2 μg/kg,95%可信区间(CI)53.8～63.6 μg/kg.结论 癫痫患者维库溴铵ED(95)为57.2 μg/kg(95% CI 53.8～63.6 μg/kg),明显大于非癫痫患者.     

罗库溴铵用于小儿的量效关系和肌松时效

目的　研究罗库溴铵用于小儿的量效关系和作用时效。方法　选择小儿与成人各40 例,用单次给药技术建立量效关系曲线,计算ED50、ED90和ED95;选择小儿与成人各10例,静脉注射 罗库溴铵600μg/kg后,记录起效时间、作用时间和恢复时间。结果　小儿与成人罗库溴铵的ED50 分别为199.6μg/kg和177.0μg/kg,ED90分别为297.8μg/kg和264.2μg/kg,ED95分别为 333.6μg/kg和295.9μg/kg;小儿与成人的起效时间分别为(84.4±15.4)s和(111.0±17.7)s,临床 肌松时间分别为(22.2±5.3)min和(28.8±6.2)min,恢复指数分别为(9.0±3.0)min和(12.5± 4.1)min,组间比较有显著性差异(P<0.05,P<0.01)。结论　小儿罗库溴铵的ED50、ED90和ED95 均大于成人,且起效快、作用时间短、恢复快。     

不同地域患者罗库溴铵药效学的比较多中心研究

目的比较中国、奥地利和美国3个不同地域的当地患者罗库溴铵作用的量效关系和时效关系。方法选择中国大连、美国英格伍德、奥地利格拉茨3个医学中心择期手术患者各18例,异丙酚、芬太尼静脉麻醉诱导后,累积剂量法进行药效学观察,首剂静脉注射罗库溴铵50μg/kg,起效后重复首剂静脉给药6次,再静脉注射罗库溴铵300μg,采用肌机械运动监测仪记录肌肉收缩强度,对数剂量．概率单位绘制剂量-反应曲线。比较3个地域患者罗库溴铵的ED50、ED90和ED95以及Dur25和Dur0．8。结果大连和格拉茨患者罗库溴铵的ED50、ED90和ED95均高于英格伍德患者,格拉茨患者的ED50、ED90和ED95高于大连患者（P＜0．05）;大连和格拉茨患者的Dur25和Dur0．8均短于英格伍德患者（P＜0．05）,格拉茨患者的Dur25短于大连患者（P＜0．05）,但两者Dur0．8的差异无统计学意义（P＞0．05）。结论3个地域患者罗库溴铵作用的量效关系和时效关系有明显的差别,临床用量需要考虑地域因素的影响。     

罗库溴铵预注和麻黄碱预处理对小儿罗库溴铵肌松起效的影响

目的 观察小儿在罗库溴铵预注、麻黄碱预处理和罗库溴铵预注复合麻黄碱预处理对罗库溴铵起效时间、插管条件和肌松时效的影响.方法 选择全麻下行择期手术的患儿80例,ASA Ⅰ或Ⅱ级,随机均分为四组.在麻醉诱导前预先静注:Ⅰ组生理盐水O.5 ml,Ⅱ组罗库溴铵0.06 mg/kg,Ⅲ组麻黄碱70 μg/kg,Ⅳ组罗库溴铵0.06 mg/kg和麻黄碱70 μg/kg.预注和预处理4min后,Ⅰ、Ⅲ组静注罗库溴铵0.6 mg/kg,Ⅱ、Ⅳ组静注罗库溴铵0.54 mg/kg.待四个成串刺激(TOF)第1个颤搐反应高度(Th)达最大阻滞程度后行气管插管.记录肌颤搐抑制75%、90%和达最大阻滞程度的时间,并评估气管插管条件,同时观察HR、BP变化.结果 Ⅰ、Ⅱ、Ⅲ、Ⅳ组的最大阻滞起效时间分别为(196±43)、(140±43)、(144±35)和(100±33)s,Ⅱ、Ⅲ、Ⅳ组的起效时间明显短于Ⅰ组(P＜0.05),Ⅳ组的起效时间较Ⅱ、Ⅲ组短(P＜0.05).各组气管插管条件均达到6～9分,优良率100%.各组麻醉诱导期间均无明显的心血管不良反应.各组的临床肌松作用时间和恢复指数差异均无统计学意义.结论 罗库溴铵预注和麻黄碱预处理分别使用均能缩短小儿罗库溴铵的肌松起效时间,而两种方法复合使用可进一步加快肌松起效,但该方法对罗库溴铵的肌松时效无明显的影响.     

术前急性高容量血液稀释对罗库溴铵量-效关系的影响

Objective To study the influence of preoperative acute hypervolaemic haemodilution (AHHD) on the dose-response relationship of rocuronium.Methods Forty patients were randomly allocated to AHHD group or control group (n=20).Anesthesia was maintained with propofol and remifentsnyl using TCI,and rocuronium was randomly given with one of six doses(60 μg/kg).AHHD was conducted with preoperative infusion of 15 ml/kg 6% hydroxyethyl starch at a rate of 30 ml/min.Neuromuscular function was assessed using an accelograph with train-of-four stimulation at wrist.The dose-response relationship of rocuronium was determined with cumulative dose-response technique.Results Hb,Hct,TPP and ALB decreased markedly (P＜0.05) after AHHD.AHHD did not result in a significant shift in rocuronium dose-response curve.There was no significant difference in ED50,ED90,and ED95 between the AHHD group[(192.1±24.9) μg/kg,(309.9±42.7) μg/kg,(322.0±44.4) μg/kg,respectively]and the control group [(178.5±34.7) μg/kg,(209.1± 47.8)μg/kg,(304.1±49.5) μg/kg,respectively].Conclusion These results demonstrate that the potency of rocuronium is not affected by AHHD,and rocuronium may become an ideal choice of relaxant in occasion of applying AHHD.     

右美托咪定滴鼻用于患儿面罩吸入麻醉诱导前镇静的半数有效量

目的 测定右美托咪定(dexmedetomidine,Dex)滴鼻用于患儿面罩吸入麻醉诱导前镇静的ED50,比较幼儿、学龄前和学龄患儿ED50的差异. 方法 选择ASA分级Ⅰ、Ⅱ级接受面罩吸入麻醉诱导的患儿,按年龄分为幼儿组(1～3岁)、学龄前组(4～6岁)和学龄组(7～12岁),每组预计35例.每组均在麻醉前1h经鼻滴入Dex,起始剂量为2μg/kg,按改良序贯法进行调整,根据上一例患儿面罩吸入诱导时的镇静满意程度,下一例患儿增加或减少0.25 μg/kg.镇静效果以面罩接受程度四分法进行评估,1～2分为镇静不满意,3～4分为镇静满意.用概率单位回归分析法计算出Dex满意镇静的ED50及相应的95％置信区间(95％CI). 结果 幼儿组、学龄前组和学龄组实际所需例数分别为31、28和30.幼儿组、学龄前组和学龄组Dex滴鼻镇静的ED50和95％CI分别为1.94(1.72～2.18)、1.61(1.41～1.82) μg/kg和1.30(1.13～1.47) μg/kg,3组间比较,差异有统计学意义(P＜0.05). 结论 随着患儿年龄的增加,面罩吸入麻醉诱导前所需Dex滴鼻镇静的ED50减小.     

Rocuronium zur elektiven Narkoseeinleitung Verlauf der neuromuskulären Blockade und Intubationsbedingungen nach 2facher ED95 (0,6 mg/kg) und nach Dosisreduktion (0,4 mg/kg)

BACKGROUND: Rocuronium is a non-depolarising neuromuscular blocking agent structurally related to vecuronium. The compound has a rapid onset and an intermediate duration of action. The rapid onset is of importance in patients at risk for pulmonary aspiration, for elective induction of anaesthesia slower onset properties generally are accepted. In this context, we asked whether the induction dose of rocuronium may be reduced to doses smaller than 2 x ED95 in situations in which slower onset properties may be acceptable. METHODS: The time course of neuromuscular block and intubating conditions of two different doses rocuronium, 2 x ED95 (0.6 mg/kg) and 1.3 x ED95 (0.4 mg/kg), were investigated in 90 patients. We first determined the time course of neuromuscular block using electromyography (EMG), n = 15 for each group. In the second part the intubating conditions 3 min after injection of either rocuronium 0.6 mg/kg or rocuronium 0.4 mg/kg were evaluated, n = 30 for each group. RESULTS: In the present study reduction of the dose of rocuronium led to a slower onset (148 +/- 32 s vs. 220 +/- 30 s; P < 0.05) and a shorter clinical duration (21 min +/- 4 vs. 36 +/- 7 min; P < 0.05). The recovery index was modified by the dose reduction: 11 +/- 3 min after 0.6 mg/kg rocuronium and 9 +/- 2 min after 0.4 mg/kg. After both doses of rocuronium the intubating conditions were good to excellent, no difference between both rocuronium groups were found. CONCLUSION: In the present study dose reduction from 0.6 mg/kg rocuronium to 0.4 mg/kg rocuronium led to a slower onset and reduced clinical duration. However, the intubating conditions, evaluated 3 min after injection of the muscle relaxant were comparable. This offers new possibilities for muscle relaxation for surgical or diagnostic procedures of short duration and may reduce costs.     

Dose-Response of Rocuronium Bromide in Children Anesthetized with Propofol: A Comparison with Succinylcholine

Background: The aim of this study was to determine the potency of rocuronium during propofol/fentanyl/N2 O anesthesia in children and to compare the time course of action of rocuronium at doses of two and three times the ED95 with that of succinylcholine.

Methods: Rocuronium (120, 160, 200, or 240 micro gram/kg) was administered to 48 children aged 2-10 yr. Neuromuscular block was assessed by monitoring the electromyographic response of the adductor digiti minimi to supramaximal stimulation of the ulnar nerve at 2 Hz for 2 s every 10 s. Potency was determined by log-probit transformation and least-squares linear regression analysis of dose and response. In a second group of 30 children, the onset and recovery profile of rocuronium at doses of two and three times the ED95 was compared with that of succinylcholine (2 mg/kg).

Results: Values for ED50 and ED95 were 210 +/- 24 and 404 +/- 135 micro gram/kg, respectively. The time to 90% neuromuscular block after 1.2 mg/kg rocuronium (three times the ED95), 33 +/- 5 s (mean +/- SD), did not differ significantly from that after succinylcholine, at 30 +/- 7 s; however, both were significantly less than that after 0.8 mg/kg rocuronium, 46 +/- 8 s (P < 0.05). The time to 25% recovery from 1.2 micro gram/kg rocuronium, 41 +/- 13 min, was approximately 50% greater than that after 0.8 mg/kg, at 27 +/- 6 min (P < 0.001), and eight times greater than that after succinylcholine, at 5.2 +/- 1.9 min (P < 0.001).     

Geographic Regional Differences in Rocuronium Bromide Dose-Response Relation and Time Course of Action: An Overlooked Factor in Determining Recommended Dosage

Background: Geographic location is not acknowledged as a stratifying factor that can directly affect drug potency, because drugs are still licensed with the same recommended dose for different geographic regions. The aim of the current study was to compare the potency and duration of action of rocuronium bromide in 54 patients in three countries with different life habits, diet, and ambient conditions, namely white Austrians, white North Americans, and Han Chinese in China.

Methods: Neuromuscular block of six consecutive 50-[mu]g/kg rocuronium incremental doses followed by 300 [mu]g/kg was evaluated using the Relaxometer mechanomyograph (Groningen University, Groningen, Holland). Dose-response curves were created using log-dose-probit transformation. The authors compared rocuronium bromide ED50, ED90, and ED95 (effective doses required for 50%, 90%, and 95% first twitch depression, respectively) as well as Dur25 and Dur0.8 (times from last incremental dose administration until 25% first twitch and 0.8 train-of-four ratio recovery, respectively) in patients of the three countries.

Results: Rocuronium ED50, ED90, and ED95 were significantly higher in Austrian patients (258 +/- 68, 530 +/- 159, and 598 +/- 189 [mu]g/kg) and Chinese patients (201 +/- 59, 413 +/- 107, and 475 +/- 155 [mu]g/kg) compared with American patients (148 +/- 48, 316 +/- 116, and 362 +/- 149 [mu]g/kg, respectively). Dur25 and Dur0.8 were significantly shorter in Austrian patients (22.3 +/- 5.5 and 36.9 +/- 12.8 min) and Chinese patients (30.4 +/- 7.5 and 45.7 +/- 15.9 min) compared with American patients (36.7 +/- 8.5 and 56.2 +/- 16.7 min, respectively).     

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。     

Geographic regional differences in rocuronium bromide dose-response relation and time course of action: an overlooked factor in determining recommended dosage

BACKGROUND: Geographic location is not acknowledged as a stratifying factor that can directly affect drug potency, because drugs are still licensed with the same recommended dose for different geographic regions. The aim of the current study was to compare the potency and duration of action of rocuronium bromide in 54 patients in three countries with different life habits, diet, and ambient conditions, namely white Austrians, white North Americans, and Han Chinese in China. METHODS: Neuromuscular block of six consecutive 50-microg/kg rocuronium incremental doses followed by 300 microg/kg was evaluated using the Relaxometer mechanomyograph (Groningen University, Groningen, Holland). Dose-response curves were created using log-dose-probit transformation. The authors compared rocuronium bromide ED50, ED90, and ED95 (effective doses required for 50%, 90%, and 95% first twitch depression, respectively) as well as Dur25 and Dur0.8 (times from last incremental dose administration until 25% first twitch and 0.8 train-of-four ratio recovery, respectively) in patients of the three countries. RESULTS: Rocuronium ED50, ED90, and ED95 were significantly higher in Austrian patients (258 +/- 68, 530 +/- 159, and 598 +/- 189 microg/kg) and Chinese patients (201 +/- 59, 413 +/- 107, and 475 +/- 155 microg/kg) compared with American patients (148 +/- 48, 316 +/- 116, and 362 +/- 149 microg/kg, respectively). Dur25 and Dur0.8 were significantly shorter in Austrian patients (22.3 +/- 5.5 and 36.9 +/- 12.8 min) and Chinese patients (30.4 +/- 7.5 and 45.7 +/- 15.9 min) compared with American patients (36.7 +/- 8.5 and 56.2 +/- 16.7 min, respectively). CONCLUSIONS: The authors demonstrated a significant difference in rocuronium potency and duration of action among patients in the three countries. Larger studies are required for determining dosage recommendations for different geographic regions.     

顺阿屈库铵临床药效学分析

目的研究顺阿屈库铵在国人中的临床药效过程。方法选择年龄30～65岁择期全麻手术病人100例。静脉诱导用异丙酚2mg/kg、芬太尼4μg/kg。各项循环监测指标稳定5min后,研究分两部分进行。第一部分将病人随机分成七组,每组10例,Ⅰ组25μg/kg、Ⅱ组30μg/kg、Ⅲ组35μg/kg、Ⅳ组40ug/kg、V组45μg/kg、Ⅵ组     

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.     

脓毒血症对大鼠罗库溴铵药效学的影响

目的 评价脓毒血症对大鼠罗库溴铵药效学的影响.方法 健康雄性SD大鼠40只,体重250～350 g,采用随机数字表法,将其随机分为对照组(C组,n=10)、假手术组(S组,n=10)和脓毒血症组(Sep组,n=20).Sep组采用盲肠结扎穿孔术制备脓毒血症模型,并于术后6和16 h时分别取10只大鼠,静脉注射罗库溴铵3.81 mg/kg;S组不结扎穿孔盲肠,仅于术后6h静脉注射罗库溴铵3.81 mg/kg.采用RM6240B型多道生理信号采集处理系统记录肌松起效时间、TOF无反应期、高峰时间、临床肌松作用时间、体内肌松作用时间、T1从最大抑制到恢复至10％、25％、50％、75％、90％的时间和恢复指数.结果与C组和S组比较,Sep组罗库溴铵肌松起效时间延长,TOF无反应期、高峰时间、临床肌松作用时间、体内肌松作用时间、T1从最大抑制到恢复至10％、25％、50％、75％、90％的时间和恢复指数缩短(P＜0.05);Sep组术后16 h时注射罗库溴铵较术后6h时注射肌松起效时间延长,T1恢复至75％的时间缩短(P＜0.05).结论 脓毒血症可降低罗库溴铵的肌松效应,其效应与脓毒血症严重程度有关.