地尔硫对罗库溴铵肌松时效及气管插管心血管反应的影响

目的探讨地尔硫对罗库溴铵肌松时效及气管插管心血管反应的影响。方法45例气管插管全麻下手术病人,随机分为3组,每组15例。麻醉诱导前静脉注射药物,对照组予氯化钠注射液10 mL;低剂量组予地尔硫0.05 mg·kg~(-1)(10 mL);高剂量组予地尔硫0.1 mg·k~(-1)(10 mL),注射时间大于30 s。3组病人在给药3 min后均静脉注射咪唑安定0.05 mg·kg~(-1),芬太尼4.0μg·kg~(-1),丙泊酚1.0 mg·kg~(-1)和罗库溴铵0.6 mg·kg~(-1)快速诱导后气管插管。监测肌松情况并记录地尔硫用药前后及气管插管前后的血压(BP)、心率(HR),计算心率收缩压的二乘积(RPP)。结果肌松监测方面,对照组的无反应期为(25±s 5)min,低于低、高剂量组无反应期(32±4)min和(33±6)min(P<0.05),低、高剂量组无显著差异(P>0.05)。对照组临床作用时间为(36±6)min,低、高剂量组分别为(43±5)min和(48±7)min,低、高剂量组长于对照组(P<0.05),虽然低剂量组临床作用时间短于高剂量组,但无显著差异(P>0.05)。起效时间与恢复指数3组间比较无显著差异(P>0.05)。与给药前相比,对照组病人在插管后BP、HR、RPP显著升高(P<0.05),低、高剂量组插管后的BP、HR及RPP变化无显著差异(P>0.05)。结论地尔硫能延长罗库溴铵的无反应期与临床作用时间,并能减少气管插管的心血管反应。

Effect of diltiazem on time-response relationship of rocuronium and cardiovascular response to tracheal intubation

AIM To investigate the effect of diltiazem on the time-response relationship of rocuronium and the cardiovascular response to tracheal intubation.METHODS Forty-five ASA gradeⅠ-Ⅱpatients undergoing elective surgical operation were randomly allocated to 3 groups(n=15).The control group was given saline 10 mL;low dose group was given diltiazem 0.05 mg·kg~(-1)(10 mL)and high dose group with diltiazem 0.10 mg·kg~(-1)(10 mL);intravenously before anesthesia induction.Anesthesia was induced with midazolam 0.05 mg·kg~(-1),fentanyl 4.0μg·kg~(-1),propofol 1.0-1.5 mg·kg~(-1)and rocuronium 0.6 mg·kg~(-1);and maintained with propofol 4-8 mg·kg~(-1)in all groups.Neuromuscular function,blood pressure(BP)and heart rate(HR)were monitored and the rate-pressure product(RPP)was calculated before and after the medication and tracheal intubation.RESULTS The maximum blockade period was significantly shorter in control group ((25±s 5)min)than those in low dose group((32±4)min)and in high dose group((33±6)min)(P<0.05).Clinical reaction duration in control group((36±6)min)was significantly shorter than those in low dose group((43±5)min)and high dose group((48±7)min)(P<0.05).There were no significant differences of the onset time and recovery index among the three groups(P>0.05).The BP,HR and RPP increased markely in control group after endotraeheal intubation(P<0.05),while those items didn't change obviously in the low dose group and high dose group(P>0.05).CONCLUSION Diltiazem can prolong the maximum blockade period and clinical duration of rocurorium with simultaneous reduction of the cardiovascular response to induction of tracheal intubation.