七氟醚复合顺式阿曲库铵对全麻患者术后苏醒质量的影响

目的观察七氟醚复合顺式阿曲库铵对全麻患者术后苏醒时间、自主呼吸恢复时间的影响及其不良反应。方法选择60例ASAⅠ～Ⅱ级成年择期全麻手术患者,随机均分为丙泊酚组（Ⅰ组）和七氟醚组（Ⅱ组）各30例。麻醉诱导后予以0.3mg／kg的顺式阿曲库铵插管;麻醉维持分别采用丙泊酚TCI-泵注瑞芬太尼-顺式阿曲库铵和吸入1～1．3倍最低肺泡有效浓度（MAC）七氟醚-泵注瑞芬太尼-顺式阿曲库铵。监测脑电双频指数（BIS）,用加速度仪进行肌松监测,观测T1恢复至25％、75％及四个成串刺激（TOF）比值（T4／T1）恢复至0．75的时间。结果两组患者的性别、年龄、体重指数、麻醉持续时间、血流动力学变化和恢复指数（T1从25％～75％时间）比较差异无统计学意义（P〉0.05）;两组苏醒时间I组比II组延长,差异有统计学意义（P〈0．05）。结论七氟醚不会延长患者苏醒时间,而且不延长顺式阿曲库铵的残余肌松作用,是理想的吸入麻醉药。     

缩短顺阿曲库铵起效时间的临床研究

目的研究预注法及限时法能否缩短顺阿曲库铵的起效时间。方法60例患者随机等分为Ⅰ组、Ⅱ组和Ⅲ组,三组诱导药均为芬太尼4μg／kg,丙泊酚2mg／kg。Ⅰ组在注入诱导药前先注入顺阿曲库铵20μg／kg,3分钟后依次注入诱导药和顺阿曲库铵80μg／kg;Ⅱ组在注入诱导药前先注入顺阿曲库铵100μg／kg,90秒后注入诱导药;Ⅲ组依次注入诱导药和顺阿曲库铵100μg／kg。用TOF-Watch监测拇内收肌神经肌肉传导功能,在肌颤搐抑制达90％时行气管插管,术中观察诱导前T1百分比,肌颤搐达90％的时间,100％抑制的时间及气管插管评级情况。结果Ⅲ组与Ⅰ、Ⅱ组比较,诱导前无T1抑制、达90％及100抑制时间均延长;患者一般情况、气管插管评级三组相近。结论预注法及限时法均能缩短顺阿曲库铵的起效时间,且两种方法所得效果无明显差异。     

Cost analysis of neuromuscular blocking agents in the operating room: cisatracurium, atracurium, vecuronium and rocuronium

Cisatracurium (C), Atracurium (A), Rocuronium (R) and Vecuronium (V) are four neuromuscular blockers (NMB) used in the operating room with similar efficacy, defined as adequate muscle relaxation, but different pharmacokinetics. C and A have organindependent elimination, A is associated with histamine release and R has a shorter onset time. The objective of this study was to economically compare these four NMB from the hospital point of view in order to facilitate drug selection. A cost analysis was performed. Only direct costs were considered and data were collected through a retrospective chart review. A total of 151 patient charts were randomly selected. Differences between patients receiving one of the four NMB were evaluated by ANOVA or KruskalWallis tests. Then a multiple linear regression analysis was conducted. In the chart review, no significant difference was observed between the four groups of patients in age, weight or surgery duration (p>0.05). Multiple regression analysis revealed that atracurium was on average PTA 237 (1 Euro = PTA 166) cheaper per surgery than any other NMB after adjusting for other factors (p<0.01) and there is no significant difference in cost between the other three NMBs (p>0.1). We recommend the use of rocuronium when a quick onset is needed and the patient does not have hepatic failure, cisatracurium when a haemodynamic instability is possible and atracurium in the remaining cases. If just one NMB can be included in the drug formulary we would select cisatracurium due to its pharmacological advantages over atracurium with a small increment in cost.     

Kinemyography (KMG) versus Electromyography (EMG) neuromuscular monitoring in pediatric patients receiving cisatracurium during general anesthesia

Aim of the workTo compare KMG versus EMG neuromuscular monitoring in pediatric patients receiving cisatracurium during general anesthesia.MethodsAfter approval of the protocol by Ethics Committee 24 pediatric patients of both sexes aged 2–6 years, with a maximum weight 20 kg, were included in the study. Monitoring equipments (Datex-Ohmeda A/S 5?) were attached to the patient. The electromyogram was attached to one hand, while, KMG was attached to the other hand for simultaneous monitoring. Induction of anesthesia with fentanyl 2 μg/kg and propofol 2 mg/kg followed by endotracheal intubation. Anesthesia was maintained by end-tidal isoflurane 1.2%. Ventilation was kept by 50% oxygen in air and was adjusted to maintain end-tidal CO₂ in the range of 35–40 mm Hg. After a stable baseline period of at least 3 min, the 24 patients were received 0.1 mg/kg cisatracurium twice the 95% effective dose (2 × ED₉₅). The following parameters were collected and compared; (1) lag time (time from start of muscle relaxant administration until the first measurable neuromuscular block (NMB), (2) onset time (time from start of muscle relaxant administration until maximal NMB), (3) assessing the recovery period by; train of four (TOF) 0.25, 0.50, 0.75 and 0.90 (time to reach a TOF ratio of 25%, 50%, 75% and 90%, respectively). No top-up doses of muscle relaxants were given.ResultsThere was no statistical difference between both studied groups as regard the demographic data of the patients, the lag time, the onset time, TOF 0.25, 0.5, 0.75 and 0.9 ratios using either EMG or KMG. In addition, there is excellent degree of agreement between EMG and KMG in measuring TOF ratio during both induction and recovery of muscle relaxants.ConclusionsKMG showed an excellent degree of agreement with EMG for determination of onset and recovery of NMB in children.     

顺式阿曲库铵对兔定量药物脑电图δ、θ频段的影响

目的探讨顺式阿曲库铵对兔定量药物脑电图(QPEEG)δ、θ频段的影响。方法采用QPEEG功率谱分析法,分析兔静脉注射顺式阿曲库铵0.3mg/kg前后δ、θ频段功率百分比的变化。结果与给药前相比,枕区δ频段功率百分比在给药后各时间点均增加(P<0.05或P<0.01),而其它各脑区δ频段功率百分比的变化差异均无统计学意义(P>0.05)。与给药前相比,各脑区θ频段功率百分比在给药后各时间点均有所增加,其中枕区和颞区增加最明显(P<0.05或P<0.01)。结论顺式阿曲库铵能够增大兔QPEEG枕区δ频段功率百分比及各脑区θ频段功率百分比。     

Storage at room temperature does not change cisatracurium onset time: a prospective, randomized, double-blind controlled study

Objective

Storage of cisatracurium at room temperature seems to have no effect on its degradation in vitro contrary to the recommendations of storage at +4 °C. The purpose of this study was to evaluate the influence of cisatracurium’ s storage temperature on its onset time.

Study design

Prospective, randomized, double-blind trial study.

Patients and methods

Thirty patients were enrolled. The control group consisted of 15 patients receiving cisatracurium (0.15 mg/kg) stored at room temperature and the intervention consisted of 15 patients receiving cisatracurium (0.15 mg/kg) stored at +4 °C. The primary endpoint was to compare cisatracurium onset time depending on the storage temperature.

Results

Cisatracurium onset time was 235 (180–292) seconds in the “room temperature” group vs. 240 (210–292) seconds in the “refrigerated” group. There was no difference between the onset of cisatracurium depending on the temperature of storage (p = 0.51). Subgroups analysis in the “room temperature” group did not show any difference in cisatracurium onset depending on whether it was stored at room temperature for one, two or three weeks. Excellent intubation score was obtained for 100% of the patients.

Conclusion

This study demonstrated that cisatracurium's storage at room temperature had no influence on its onset time. It provides an argument for the preservation of cisatracurium at room temperature for a period not exceeding 21 days. Monitoring the onset of curarization may increase the quality score of intubation.     

舒芬太尼对顺式阿曲库铵起效时间的临床观察

目的采用单次注射法探讨舒芬太尼对全麻病人顺式阿曲库铵起效时间的影响。方法ASAI～II级择期全麻手术患者60例,随机分为2组;单纯丙泊酚（A组）,丙泊酚复合舒芬太尼（B组）。A组麻醉诱导采用丙泊酚2mg/kg;B组麻醉诱导采用丙泊酚2mg/kg,舒芬太尼1ug/kg。A组和B组诱导时静注顺式阿曲库铵0.15mg/kg,待肌松抑制达到最大（T1=0）行气管插管,通过记录刺激尺神经时拇指内收肌的收缩加速度诱导期采用单个刺激（频率0.1Hz,持续0.2ms）监测肌松起效时间（顺式阿曲库铵注药毕至肌颤搐抑制100%的时间）。结果顺式阿曲库铵起效时间在二组之间无显著差异P〉0.05）。结论舒芬太尼并不影响全麻患者顺式阿曲库铵起效时间。     

糖尿病患者顺式阿曲库铵肌松效应的探讨

目的：在闭环输注系统（CLMRIS-1）指导下比较糖尿病患者与非糖尿病患者顺式阿曲库铵的肌松效应,并探讨糖尿病患者血清中α1-酸性糖蛋白（AAG）水平的变化及其对顺式阿曲库铵药效的影响。方法选择60例拟在全麻下行腹部外科手术的患者,ASAⅠ~Ⅱ级,依据其是否合并2型糖尿病,分为糖尿病组（D组）和非糖尿病组（C组）。麻醉诱导前15 min及术毕即刻,分别抽取静脉血3 ml,离心后取上清1 ml,于-20℃冰箱中保存并及时送检,测定血清中AAG的水平。麻醉诱导采用舒芬太尼、依托咪酯、顺式阿曲库铵。记录两组患者肌松药起效时间T0（注药毕至T1抑制至0的时间）,恢复指数RI（T1从25%恢复至75%的时间）及TOF90（TOF从25%恢复至90%的时间）。结果2组患者顺式阿曲库铵的起效时间[（4.0±1.1）min vs.（4.1±1.2）min]、恢复指数[（16.8±5.0）min vs.（16.5±3.1）min]及TOF90[（75.0±9.1）min vs.（73.2±6.8）min]差异均无统计学意义（P>0.05）。同时2组患者术前及术毕即刻血清中AAG水平[（69.1±7.2）mmol/L vs.（68.4±6.7）mmol/L,（69.4±9.8） vs.（68.5±6.2）mmol/L]的差异也无统计学意义（P>0.05）。结论血糖控制良好的糖尿病患者与非糖尿病患者相比,顺式阿曲库铵的肌松效应并无明显改变,血清中AAG的水平也无明显升高。     

新斯的明拮抗老年患者术后肌松药残留阻滞作用的量效研究

目的 研究老年患者术后使用新斯的明拮抗顺式阿曲库铵肌松药残留阻滞作用的量效关系。方法 选择深圳市第二人民医院2013年2~9月在全凭静脉麻醉下行腹腔镜胆囊摘除术的老年患者80例,分为4组,每组各20例,即T0,T5,T10和T20组。术后当4个成串刺激比值(TOFR)恢复至0.5时,T5,T10和T20组患者分别静脉注射新斯的明5,10,20μg/kg,而T0组注射生理盐水。记录TOFR恢复到1.0的时间,记录给药前及给药后第3、5、10分钟的心率(HR),血压(BP)的变化,计算各组10 min内TOFR成功恢复到1.0的百分率,以及术后6 h恶心呕吐的发生率。结果 1T0组比较,T20组TOFR恢复到1.0时间明显缩短,T20组中10 min内TOFR成功恢复到1.0的百分率增加,差异有统计学意义(P<0.05);而T5组及T10组在TOFR恢复到1.0时间以及10 min内TOFR成功恢复到1.0的百分率与T0组比较,差异无统计学意义(P>0.05)。2T20组在第3、5、10分钟的HR与给药前比较明显降低,差异有统计学意义(P<0.05)。T0组、T5组及T10组在给药前后HR变化差异无统计学意义(P>0.05),各组给药前后BP变化差异无统计学意义(P>0.05)。3各组术后6 h恶心呕吐发生率差异无统计学意义(P>0.05)。结论 在老年患者腹腔镜胆囊切除术后,当TOFR恢复至0.5时,使用20μg/kg新斯的明可有效的拮抗顺式阿曲库铵的残留作用,20μg/kg剂量新斯的明可导致老年患者心率减慢,但不增加术后恶心呕吐发生率。     

增大顺阿曲库铵剂量与罗库溴铵麻醉诱导效果的比较

目的通过观察不同剂量顺阿曲库铵的起效时间、临床有效时间的变化,并与罗库溴铵比较,为临床手术患者个体化选择肌松药物及剂量提供理论依据。方法ASAI～Ⅱ级择期妇科手术女性患者120例,随机分为4组,每组30例,分别予顺阿曲库铵0．1mg／kg（A组）、0．15mg／kg（B组）、O．2mg／kg（c组）和罗库溴铵0．9mg／kg（D组）,咪达唑仑、芬太尼、异丙酚诱导麻醉,观察心率、血压和全身皮肤情况以及TOF的变化,并进行气管插管条件评级。结果各组肌松药起效时间分别是（226±57）s、（184±56）s、（135±45）s、（80-．I-25）S,C组分别与A、B、D相比较均有统计学意义（P〈0．05）;各组临床有效时间分别是（334±5）min、（41±8）min、（534±8）min、（42±11）min,C组分别与A、B、D相比较差异均有统计学意义（P〈0．05）。c组临床有效时间的离差与D组相比较差异有统计学意义（P〈0．05）。结论增大剂量法明显缩短顺阿曲库铵的插管起效时间,但与罗库溴铵相比,临床作用时间延长,便不适于短小外科手术的麻醉,而罗库溴铵临床作用时间的变异性较大,顺阿曲库铵的可控性优于罗库溴铵。