肝移植手术不同分期对罗库溴铵药效学的影响

目的观察肝移植术中罗库溴铵的药效学。方法全身麻醉下肝移植术患者30例，随机分为罗库溴铵间断组（Ⅰ组）和连续输注组（Ⅱ组）。采用TOF刺激方式，监测拇内收肌收缩反应，记录肌松效应及用药量等。结果两组年龄、体重、尿量、出血量、无肝期及手术时间的差异无统计学意义。两组肌松起效和恢复时间及用药量差异无统计学意义。Ⅰ组无肝期临床作用时间（97．9±26．1）min和新肝期肝动脉开放前第一次给药的作用时间（82．0±20．9）min，明显长于无肝前期（65．0±22．2）min。Ⅰ组和Ⅱ组无肝期及新肝期罗库溴铵的用量分别为（1．61±1．18，2．16±1．23）μg·kg^-1·min^-1和（1．44±0．53，2．01±1．24）μg·kg^-1·min^-1，显著低于无肝前期（5．07±1．01，5．68±1．75）μg·kg^-1·min^-1。术中转氨酶显著升高（P〈0．01），血尿素氮和肌酐有增高趋势，肌酐清除率有降低趋势。无肝期和新肝初期内环境变化显著。结论肝移植术中间断和连续两种给药方式，罗库溴铵的用药量和肌松恢复时间相似。无肝期肝功能缺如、新肝缺血再灌注及肝动脉化，以及肝外途径等协同作用，使得无肝期和新肝期罗库溴铵的作用时间延长，维持同等程度肌松时用药量明显低于无肝前期。     

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.     

乳腺癌术前化疗对罗库溴铵肌松效应的影响

目的 研究乳腺癌术前化疗对罗库溴铵肌松效应的影响.方法 全麻下肌松监测乳腺癌手术患者43例,分为术前化疗组(A组,25例)和未进行化疗组(B组,18例).两组术前均未用对肌松有影响的药物.用加速度仪监测拇内收肌收缩反应,观察罗库溴铵0.6 mg/kg静注后肌松时效的差异.结果 A、B两组起效时间分别为(93±18)S和(96±19)s,差异无统计学意义;A组临床时效长于B组[(49±16)min vs.(37±13)min],A组恢复指数也长于B组[(14.2±3.0)min vs.(10.9±2.5)min](P<0.05).结论 乳腺癌术前化疗对罗库溴铵的临床作用时效和恢复延长.     

琥珀胆碱对罗库溴铵肌松作用的影响

目的：本试验应用ＰＩ控制器自动化反馈控制罗库溴铵的输注,将肌松维持在恒定水平,通过确定罗库溴铵的稳态输注速率,来研究琥珀胆碱对罗库溴铵肌松作用的影响。方法：选择１４例ＡＳＡ分级Ⅰ～Ⅱ级的手术病人,随机分成对照组（７例）和试验组（７例）。对照组在麻醉诱导后,静注０．６ｍｇ／ｋｇ罗库溴铵进行气管插管;试验组则静注１．５ｍｇ／ｋｇ琥珀胆碱后气管插管,待肌松作用完全恢复后,再静注０．６ｍｇ／ｋｇ罗库溴铵,     

罗库溴铵在老年病人的肌松效应

目的：探讨罗库溴铵在老年病人的肌松效应。方法：３０ 例ＡＳＡⅠ～Ⅱ级接受芬太尼异丙酚静脉复合麻醉的病人分为老年组（ ｎ ＝ １５,年龄７２－４ ±４－０ 岁） 和青壮年组（ｎ ＝ １５,年龄３０－６ ±１１－６ 岁）。在静脉注射罗库溴铵０－６ｍｇ／ｋｇ 后用加速度仪检测其起效时间、无反应期、Ｔ１２５ ％ 恢复时间、Ｔ１７５％ 恢复时间及恢复指数。结果：老年组病人与青壮年组病人相比,罗库溴铵的起效时间无明显差别（８３－６ ±２２－５ｖｓ８８－１ ±２４－０ 秒,Ｐ＞ ０－０５）,但老年组的无反应期（３６－３ ±１０－６ｖｓ２０－０ ±６－７ 分钟,Ｐ＜ ０－０１） 、Ｔ１２５％ 恢复时间（５２－６ ±１７－９ｖｓ２８－５ ±７－２ 分钟,Ｐ＜ ０－０１）、Ｔ１７５ ％ 恢复时间（７５－８ ±２０－０ｖｓ３８－９±９－４ 分钟,Ｐ＜ ０－０１）及恢复指数（３３－２ ±９－２ｖｓ１０－４±５－０ 分钟,Ｐ＜ ０－０１）均显著延长。结论：在老年病人,罗库溴铵的肌松作用时间延长。     

七氟醚对罗库溴铵肌松效应的影响

目的 观察七氟醚对罗库溴铵肌松作用的影响.方法 成人全麻手术患者60例随机均分为三组.每组20例.Ⅰ组丙泊酚静脉麻醉,Ⅱ组吸入七氟醚(1 MAC)15 min,Ⅲ组吸入七氟醚(1 MAC)45 min.在麻醉平稳(Ⅱ、Ⅲ组在呼气末七氟醚浓度稳定在1 MAC)后静脉注射罗库溴铵0.6 mg/kg,记录TOFr的变化.结果 Ⅱ、Ⅲ组罗库溴铵的起效时间分别为97.60 s和94.50 s,明显短于Ⅰ组的119.90 s(P<0.05);Ⅱ和Ⅲ组完全肌松时间(T1消失)明显长于Ⅰ组(32.7 min和44,6 min vs.21.3 min)(P<0.05),Ⅲ组明显长于Ⅱ组(P<0.05);TOF的T2～T4出现的时间及TOFr恢复到25%、50%和75%的时间,Ⅱ、Ⅲ组均长于Ⅰ组,且Ⅲ组长于Ⅱ组(P<0.05).结论 持续吸入1 MAC七氟醚能随吸人时间延长而增强罗库溴铵的神经肌肉阻滞效应.     

罗库溴铵预注效果的临床研究

目的：研究较库溴争的预注效果。方法：ＡＳＡⅠ－Ⅱ级择期全麻手术４６例,男２５例,女２１例,分为三组。Ⅰ组用罗库溴铵预注法导插管,应用正交试验Ｌ（３＾７）方法,观察０．０４５、０．０６、０．０７５ｍｇ／ｋｇ三种不同水平的预注量（ＰＤ）,２、３、４分钟预注时间（ＰＩ）及０、３、０．４５、０．６ｍｇ／ｋｇ插管剂量（ＩＤ）地预注效果的影响,Ⅱ组（ｎ＝１８）用罗库溴铵０．３、０．４５、０．６ｍｇ／ｋｇ常规诱     

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     

罗库溴铵和维库溴铵对大鼠离体膈肌神经肌肉接头钾离子通道的影响

目的利用成年大鼠膈肌膈神经不均匀牵拉标本,探讨罗库溴铵和维库溴铵对神经肌肉接头部位钾离子通道的影响。方法成年健康Wister大鼠,快速处死制备离体大鼠膈神经肌肉标本并制成不均匀牵张膈肌膈神经标本。观察两药相当大鼠0.5×ED95剂量时的血药浓度药物对选择性钾离子通道阻断药3,4-二氨基吡啶(3,4-DAP)引起的终板电位(EPP)时程的作用。结果罗库溴铵自给药后2min起能够明显缩短由3,4-DAP引起的70%EPP时程的延长。而维库溴铵对由3,4-DAP引起的EPP时程的延长无明显影响。结论罗库溴铵能明显缩短由钾离子通道阻断药3,4-DAP引起的EPP时程延长作用。     

七氟醚对罗库溴铵肌松效应的影响

目的 研究吸入不同浓度的七氟醚对不同剂量的罗库溴铵肌松效应的影响.方法 90例择期手术患者随机均分为六组.记录各组静注罗库溴铵后其起效时间、四个成串刺激(TOF)无反应时间、T1 25%恢复时间、T1 75%恢复时间及恢复指数(T1 25%恢复到75%的时间).结果 静注等效剂量的罗库溴铵Ⅲ组与Ⅰ组、Ⅳ组与Ⅱ组比较,起效时间差异无统计学意义.而静注等效剂量的Ⅴ组与Ⅰ组、Ⅵ组与Ⅱ组比较,起效时间明显缩短(P＜0.05);在无反应时间、T1 25%恢复时间、T1 75%恢复时间及恢复指数上,复合吸入七氟醚的Ⅲ到Ⅵ组较注入等效剂量的罗库溴铵Ⅰ组与Ⅱ组比较均有明显的延长(P＜0.05或P＜0.01);Ⅱ组与Ⅲ组之间以及Ⅳ组与Ⅴ组之间罗库溴铵的肌松维持时间差异无统计学意义.结论 七氟醚能明显延长罗库溴铵的作用时间,有时间依赖及剂量依赖趋势.     

地氟醚对罗库溴铵肌松效应的影响

目的研究地氟醚对罗库溴铵肌松效应的影响。方法成人全麻手术患者30例,随机分为3组静脉麻醉组(Ⅰ组)、吸入地氟醚(1MAC)15min组(Ⅱ组)和45min组(Ⅲ组)。Ⅰ组在麻醉平稳后,Ⅱ组和Ⅲ组分别在呼气末地氟醚浓度稳定15min和45min时静注罗库溴铵0.6mg·kg-1,用肌松监测仪监测TOF(四个成串刺激)的变化。结果Ⅱ组的T1和TOF比值起效时间(min)分别为1.3和0.8,与Ⅰ组2.2和1.5比较,明显缩短(P<0.05);临床肌松时间(T1值恢复至25％基础值的时间)3组分别为29.6,31.7和37.8min,Ⅲ组与Ⅰ组比较明显延长(P<0.05);T     

营养不良对罗库溴铵肌松作用的影响

目的 研究营养不良对罗库溴铵肌松作用的影响。方法 选择 ASA I-Ⅱ级全麻行择期手术的病人48例,按体重指数将病人分为4组:I组为正常对照组、Ⅱ组为轻度营养不良组、Ⅲ组为中度营养不良组、Ⅳ组为重度营养不良组。用肌松监测仪监测四个成串刺激（TOF）的变化,记录罗库溴铵插管剂量（0.6mg·kg-1）和维持剂量（0.15 mg·kg-1）的肌松指标。结果 插管剂量的罗库溴铵,在Ⅲ组和Ⅳ组的起效时间延迟[（184.7±58.1）s和（251.8±62.1）s,P<0.05],在Ⅳ组的T1最大抑制程度下降为95.17％±3.88％（P<0.05）,在Ⅲ组和Ⅳ组的时效缩短为（26.4±6.3）min和（25.0±7.1）min（P<0.05）。维持剂量的罗库溴铵,在Ⅲ组和Ⅳ组的时效缩短为（18.8±4.0）min和（17.0±4.2）min（P<0.05）。恢复指数在各组间无差别（P>0.05）,Ⅱ组的各指标与Ⅰ组比较无统计学差异（P>0.05）。结论 按实际体重给药,罗库溴铵在中度和重度营养不良病人身上的肌松作用减弱。     

异氟醚吸入麻醉与异丙酚静脉麻醉下长时间持续输注罗库溴铵的肌松作用

目的比较异氟醚吸入麻醉与异丙酚静脉麻醉下长时间持续输注罗库溴铵的肌松作用。方法拟在全麻下行口腔-颌面肿瘤择期手术(手术时间达5 h左右)病人30例,ASAⅠ或Ⅱ级,年龄18～65岁,随机分为2组(n=15):异丙酚组(Ⅰ组)异氟醚组(Ⅱ组)。用TOF-Watch SX肌松监测仪进行拇内收肌肌松监测。静脉注射罗库溴铵初始剂量0．6 mg·kg-1后气管插管,持续输注罗库溴铵。调整罗库溴铵的输注速率,T1稳定在基础值的10％时(初始状态),Ⅰ组靶控输注异丙酚维持麻醉,Ⅱ组吸入1 MAC异氟醚维持麻醉,持续5 h,术中维持T1在基础值的10％。记录罗库溴铵输注速率、恢复指数(T1恢复25％至75％的时间,T25-75)以及罗库溴铵停止输注到TOFR为0．9的时间。结果与初始状态比较,Ⅰ、Ⅱ组持续给药30 min-5 h时罗库溴铵输注速率下降(P<0．05);Ⅱ组持续给药1～5 h时罗库溴铵输注速率低于Ⅰ组(P<0．05)。两组间恢复指数和罗库溴铵停止输注到TOFR为0．9的时间差异无统计学意义(P>0．05)。结论罗库溴铵可用于长时间持续输注以维持稳定的肌松。维持T1在基础值的10％的情况下,持续输注罗库溴铵5 h时异氟醚麻醉比异丙酚为主的全凭静脉麻醉罗库溴铵输注速率减少30％,但其恢复指数无差异。     

罗库溴铵对维族患者全麻诱导时熵指数的影响

目的 探讨罗库溴铵对维族患者全麻诱导时熵指数的影响.方法 择期行全麻手术的维族患者40例,性别不限,年龄20～50岁,体重45～70kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分为2组(n=20):生理盐水对照组(NS组)和罗库溴铵组(R组).靶控输注异丙酚,初始血浆靶浓度为2μg/ml,每隔4 min递增0.5μg/ml,直至反应熵(RE)降至45并维持4 min,血浆浓度和效应室浓度平衡时,R组静脉注射罗库溴铵0.6 mg/kg,NS组给予等容量生理盐水,3 min后静脉注射芬太尼3μg/kg诱导气管插管后行机械通气.于麻醉诱导前即刻(T0)、注射罗库溴铵前(T1)、注射后2 min(T2)、气管插管后即刻、1、2和3 min时(T3-6)记录状态熵(SE)和RE,并计算RE-SE差值.结果 与NS组相比,R组T3,4时RE值降低,T2-5时RE-SE差值降低(P＜0.05).结论 罗库溴铵可降低维族患者全麻诱导时RE值和RE-SE差值的增高幅度,可能影响熵指数监测麻醉深度的准确性.

Abstract：

Objective To investigate the effect of rocuronium on spectral entropy during induction of general anesthesia in patients of Uygur nstionality. Methods Forty ASA Ⅰ or Ⅱ patients (Uygur nationality) of both sexes, aged 20-50 yr, weighing 45-70 kg, undergoing elective surgery under general anesthesia, were divided into 2 groups ( n = 20 each): normal saline (NS) group and rocuronium group (group R). Anesthesia was induced with target-controlled infusion of propofol. The initial target plasma concentration wan net at 2 μg/ml. The concentration wan then increased by 0.5 μg/ml every 4 min until response entropy (RE) was decreased to 45 and maintained for 4 min. When the plasma concentration was equal to the effect-site concentration, iv rocuronium 0.6 mg/kg was injected in group R, while group NS received the equal volume of NS instead. Fentanyl 3 μg/kg was injected intravenously at 3 min after recuronium administration. The patients were tracheal intubated and mechanically ventilated. State entropy (SE) and RE were recorded immediately before induction (baseline, To), before rocuronium administration (T1), 2 main after rocuronium administration (T2) and at 0, 1, 2 and 3 min after intubation (T3-6). The difference between RE and SE wan calculated. Results The RE value at T3 and T4 and the difference between RE and SE at T2.5 were significantly lower in group R than in group NS ( P ＜ 0.05). Conclusion Rocuronium can decrease the RE value and degree of increase in the difference between RE and SE during induction of general anesthesia in patients of Uygur nationality, which may affect the accuracy of spectral entropy in monitoring the depth of anesthesia.     

Evaluation of intense neuromuscular blockade caused by rocuronium using posttetanic count in male and female patients

STUDY OBJECTIVE: To establish the relationship between train-of-four (TOF) nerve stimulation and the number of posttetanic twitches (posttetanic count [PTC]) during neuromuscular blockade caused by rocuronium in males and females. DESIGN: Prospective, observational, clinical comparison. SETTING: Operating room of a university hospital. PATIENTS: 60 ASA physical status I and II patients (30 women and 30 men), aged 18 to 60 years, who were scheduled for elective orthopedic surgery and ear, nose, throat surgery with a planned duration of 2 hours. INTERVENTIONS; During fentanyl, propofol, and nitrous oxide (N(2)O) anesthesia, neuromuscular blockade was evaluated with accelerometry of the thumb using TOF and posttetanic twitch stimulation (PTTS) of the ulnar nerve in patients who received rocuronium 1 mg.kg(-1). MEASUREMENTS AND MAIN RESULTS: The first responses to PTTS were seen at mean times of 34.9 and 37.7 minutes after rocuronium injection in male and female patients, respectively (NS). The average interval between the appearance of a posttetanic response and the first response to TOF stimulation (T1) was not significantly different between male and female patients (15.4 +/- 4.8 min (SD) vs. 15.9 +/- 4.9 min, respectively). There was a significant negative correlation between PTC and the time to first response to TOF nerve stimulation (r = -0.83; p = 0.0001). Gender did not have a statistically significant effect on this relation (F = 0.9; p = 0.34). The intervals from administration of rocuronium to the first appearances of T1 and T2 were not significantly different between the two groups, but the intervals to the first appearances of T3 and T4 were significantly longer in female patients. CONCLUSIONS: Even though the times from initial administration of rocuronium 1 mg.kg(-1) to the first appearances of T3 and T4 are significantly longer in female patients, the intervals to the first detectable responses to PTTS and TOF are not significantly different between females and males. Gender has no significant effect on the relation between PTC and the time to T1.     

瑞芬太尼对全麻患者罗库溴铵肌松作用的影响

目的评价瑞芬太尼对全麻患者罗库溴铵肌松作用起效、维持和恢复时间的影响。方法45例择期手术患者,年龄20～65岁,ASAⅠ或Ⅱ级。随机分为3组(n=15):单纯异丙酚组(P组)、异丙酚复合瑞芬太尼组(R组)和单纯异氟醚组(Ⅰ组),观察并记录静脉注射插管剂量(2×ED95)的罗库溴铵后各组患者肌松起效、维持和恢复时间以及自主呼吸恢复的情况。结果三组肌松起效时间比较差异无统计学意义(P>0．05);Ⅰ组肌松维持时间、75％恢复时间和恢复指数均长于P组和R组(P<0．05),R组与P组比较差异无统计学意义(P>0．05)。R组患者术中无一例恢复自主呼吸,与Ⅰ组和P组比较差异有统计学意义(P<0．01)。结论术中靶控输注瑞芬太尼对罗库溴铵的肌松作用无影响。     

体重指数对全麻患者麻醉诱导时按体重给药罗库溴铵药效学的影响

目的 研究体重指数(body mass index,BMI)对患者全身麻醉时罗库溴铵肌松作用的影响. 方法 择期行全麻手术患者80例,美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级,80例,年龄20岁～60岁.根据BMI将患者分为3组:超重组(Ⅰ组)30例,正常体重组(Ⅱ组)30例和低体重组(Ⅲ组)20例.5s内推注罗库溴铵0.9 mg/kg,记录从推药到T1为0％的时间(起效时间)、无反应期(T1为0％的时间)和恢复指数(T1由25％至75％的时间). 结果 Ⅰ组、Ⅱ组和Ⅲ组的起效时间分别为(75±15)、(91±23)、(135±27)s,Ⅰ组的起效时间短于Ⅱ组和Ⅲ组(P＜0.01),Ⅱ组又短于Ⅲ组(P＜0.01).Ⅰ组、Ⅱ组和Ⅲ组的无反应期分别为(49±14)、(37±8)、(28±7) min,Ⅰ组的无反应期则长于Ⅱ组和Ⅲ组(P＜0.01),Ⅱ组又长于Ⅲ组(P＜0.01).3组的恢复指数的比较差异无统计学意义(P＞0.05). 结论 按体重静注罗库溴铵,BMI是影响该药起效时间和无反应期的重要因素之一.     

No effect of neuromuscular blockade on the temporomandibular joint position during general anesthesia.

In an attempt to determine the role that nondepolarizing neuromuscular blocking agents play in the intraoperative position of the mandibular condyle, occlusal checkbites were taken on 10 patients under general anesthesia before and after neuromuscular blockade with vecuronium. These checkbites were compared to checkbites taken preoperatively. Nondepolarizing neuromuscular blocking agents had no effect on condylar position recordings during general anesthesia. The results demonstrate that general anesthesia itself is by far the dominant factor in intraoperative condylar position changes.