阿屈库铵对离体原代培养大鼠肝细胞的毒性研究

目的：研究阿屈库铵对离体鼠肝细胞的毒性作用。方法：采用离体鼠肝细胞培养方法，以培养基中乳酸脱氢酶（ＬＤＨ）释放量及肝细胞内Ｋ＋含量的变化为定量指标。结果：阿屈库按（５～５００μｇ／ｍｌ）使离体培养肝细胞ＬＤＨ净释放量增加，细胞内Ｋ＋含量明显减少（Ｐ＜０．０１）。结论：阿屈库铵对离体鼠肝细胞有毒性，并随浓度的增加而加重；用ＴＯＴＰ（ｔｒｉｏｒｔｈｏｔｏｌｙｌｐｈｏｓｐｈａｔｅ）抑制阿屈库铵水解降解途径的同时抑制了ａｃｒｙｌａｔｅｓ的灭活，加重其细胞毒性，表明阿屈库铵毒性的根源可能为ａｃｒｙｌａｔｅｓ。     

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.     

Residual curarisation: a comparative study of atracurium and pancuronium

Sixty patients (17-78 years old, ASA group I-II) were included in the study, which was triple-blind, randomised, stratified and controlled. Patients were selected in pairs according to sex and type of operation, and randomly allocated to one of two groups, atracurium or pancuronium. Anaesthesia was achieved with thiopentone, pethidine and nitrous oxide in oxygen, and patients were then given atracurium 0.1 mg kg-1 or pancuronium 0.6 mg kg-1. Incremental doses were administered when clinically indicated. On recovery, residual curarisation was evaluated clinically and with the train-of-four method by a doctor who was unaware of the neuromuscular blocking agents used. Residual curarisation was found to be less after neuromuscular blockade with atracurium in the doses used in this study. Atracurium has advantages in this respect when neuromuscular monitoring is not used during operation.     

不同剂量阿曲库铵对脑肿瘤切除术患者MEP、SEP水平及不良反应的影响研究

目的:研究不同剂量阿曲库铵对脑肿瘤切除术患者运动诱发电位、体感诱发电位及不良反应的影响.方法:选取2016年6月～2019年6月收治的脑肿瘤切除术患者125例为研究对象,根据使用阿曲库铵剂量不同分为小剂量组40例、中剂量组43例和大剂量组42例.比较三组生命体征情况、麻醉剂用量、麻醉剂血药浓度、运动诱发电位、体感诱发电...     

异氟醚对阿屈可林肌松作用的影响

１８例肺叶切除术病人分二组，分别静滴阿屈可林加异氟醚吸入与单独阿屈可林静滴。应用Ｄａｔｅｘ多功能气体监测仪监测异氟醚吸入呼出浓度。应用上海产微电脑微滴器节每小时用时。分别记录各组阿屈可林每小时每公斤的用量。结果显示，吸入组较未吸入组少用２８％药量，说明异氟醚有增强阿屈可林神经肉阻滞作用。     

Vecuronium and Atracurium in the Elderly: A Clinical Comparison with Pancuronium

The intubating conditions, time to complete block and duration of clinical relaxation were observed in a group of 101 elderly patients (aged over 65 years) following pancuronium 0.1 mg kg^-1, vecuronium 0.1 mg kg^-1 or atracurium 0.5 mg kg^-1. The intubating conditions in the three groups were similar when assessed at 2 min following relaxant administration. The time to complete block was shortest with vecuronium (4.3 min) in comparison to atracurium (5.0 min) and pancuronium (6.0 min), but the differences were not statistically significant. The duration of clinical relaxation, however, was significantly shorter with vecuronium (37 min) and atracurium (35 min) in comparison to pancuronium (99 min).     

Clinical manifestations and neurodevelopmental outcome following an event of accidental intramuscular injection of atracurium in newborns

Pediatric populations are at risk for medication errors that may be associated with mortality and disability. The purpose of this study was to describe the clinical manifestations of seven newborns following an event of accidental intramuscular injection of atracurium and to assess the impact on neurodevelopmental outcome. This study enrolled seven newborns who were accidentally administered 10 mg of atracurium, equivalent to 2.6–3.3 mg/kg, in a local perinatal clinic. Accident reports and hospital records were reviewed to obtain the history and medical data for the event. The survivors were prospectively examined for their growth, health and neurodevelopment until 24 months of age. All newborns showed immediate apnea and cyanosis requiring resuscitation after atracurium injection and presented with respiratory failure and flaccid paralysis on arrival for emergency medical services. One newborn was asystolic despite resuscitation and died of multiple organ failure. Of the five survivors available for follow-up, all achieved favorable growth outcomes. However, four showed mild to significant delay in development; and two manifested mild hypomyelination of cerebral white matter on the brain magnetic resonance imaging. Conclusion: Newborns accidentally injected with high doses of atracurium are at risk of death and neurodevelopmental delay. The serious clinical manifestations, developmental delay and cerebral hypomyelination were most likely due to insufficient immediate respiratory assistance following atracurium injection.     

阿曲可林和维库溴铵间歇静注法和持续静滴法的比较研究

本文在８０例颅脑胸腹部等手术病人，通过ＴＯＦ监测神经肌接头功能，观察阿曲可林和维库溴铵间歇静注和持续静滴两种给药方法的肌松程度、用药量和恢复时间。结果：（１）间歇静注需频繁给药，肌松程度波动较大，持续静滴法肌松程度恒定。（２）维持肌颤搐２５％以下的静注法与维持肌颤搐５－１０％的静滴法的用药量几乎相等，阿曲可林为６．０５～６．７１μｇ／ｋｇ／ｍｉｎ，维库溴铵为１．１１～１．１２μｇ／ｋｇ／ｍｉｎ。（     

依托咪酯对泮库溴铵和阿曲库铵肌松作用影响的实验研究

通过２８只 Ｗｉｓｔａｒ大鼠坐骨神经-胫前肌在体研究，观察了静脉麻醉药依托咪酯（０． ６ｍｇ／ｋｇ）对洋库溴铵和阿曲库铰神经肌肉阻滞效应的影响。结果显示依托咪酯对泮库溴铵和阿曲库铵的ＥＤ５０和ＥＤ９０无影响；对它们的恢复时间有较明显的延长趋势，恢复指数分别延长６７． ５％和 ５３％， １０％～９０％恢复时间分别延长６４％和４６％，但均无统计学显著性差异（Ｐ＞０．０５）。