顺式阿曲库铵同罗库溴铵联合应用时药效学变化

目的探讨全静脉麻醉下顺式阿曲库铵同罗库溴铵联合应用时药效学的变化。方法将择期行耳鼻喉科手术患者48例随机分为4组,采用全静脉麻醉,研究期间维持同等麻醉深度（BIS值40～50）。分别给予2倍ED95罗库溴铵（ⅠA和ⅠB组）或顺式阿曲库铵（ⅡA和ⅡB组）,采用TOF刺激方式监测拇内收肌的收缩反应。待T1恢复至25%（ⅠA和ⅡA组）或75%（ⅠB和ⅡB组）时追加1/2倍ED95顺式阿曲库铵。记录各组追加顺式阿曲库铵后,神经肌肉最大阻滞程度,神经肌肉阻滞达最大程度的时间（Tmax）,T1恢复至25%（T25）、75%（T75）、95%（T95）的时间,TOF比值恢复到70%的时间（TR70）以及肌松恢复指数（RI）。结果ⅠA组最大阻滞程度（T1最小值0.6%）较ⅡA组（T1最小值5.3%）显著增强（P〈0.05）;ⅠB组最大阻滞程度（T1最小值2.9%）较ⅡB组（T1最小值12.6%）显著增强（P〈0.05）。ⅠA组T25（22.8min）较ⅡA组（16.4min）延长39%（P〈0.05）;ⅠB组T25（16.2min）较ⅡB组（11.6min）延长40%（P〈0.05）。ⅠA组T95（37.7min）较ⅡA组（30.9min）延长22%,P〈0.05;ⅠB组T95（30.5min）较ⅡB组（25.9min）延长18%（P〈0.05）。ⅠA组RI与ⅡA组相比,ⅠB组RI与ⅡB组相比均无显著性差异。结论罗库溴铵在肌松作用恢复期可影响维持剂量顺式阿曲库铵的肌松作用,显著增强其阻滞程度,延长其维持时效,但对其恢复指数无影响。

Pharmacodynamic interactions between cisatracurium and rocuronium

Objectives To evaluate the interaction between cisatracurium and rocuronium when administered the maintenance doses of cisatracurium after rocuronium in total intravenous anesthesia.Methods Forty-eight patients scheduled for ENT （ears, nose, throat） surgery undergoing total intravenous anesthesia anesthesia with propofol by TCI and fentanyl were randomized to receive the following.interventions Group ⅠA=rocuronium 0.6mg/kg followed by cisatracurium 0.025 mg/kg when T1 recovered to 25%; Group ⅠB =rocuronium 0.6 mg/kg followed by cisatracurium 0.025 mg/kg when T1 recovered to 75%; Group ⅡA =cisatracurium 0.1mg/kg followed by cisatracurium 0.025 mg/kg when T1 recovered to 25%; Group ⅡB =cisatracurium 0.1mg/kg followed by cisatracurium 0.025 mg/kg when T1 recovered to 75%.The bispectral index was kept between 40 and 50 during maintenance of anesthesia.Thumb adductorius contractile response was monitored with TOF stimulation.Results Compared with group Ⅱ A （5.3% ）, the minimum value of T1 in group Ⅰ A （0.6% ） was significantly lower; compared with group ⅡB（12.6%）, the minimum value of T1 in group ⅠB（2.9%） was significantly lower too （P0.05）.The time of 25% T1 recovering of the control value （T25） was prolonged by 39% in group ⅠA（22.8min） compared with ⅡA（16.4min）,and 40% in group ⅠB（16.2min）compared with ⅡB（11.6min）（P0.05）.The time of 95% T1 recovering of the control value （T95） was prolonged by 22% in group ⅠA（37.7min）compared with IIA（30.9min）,and 18% in group ⅠB（30.5min）compared with ⅡB（25.9min）（P0.05）.There was no difference between group ⅠA（9.7min）and ⅡA （9.7min）,group IB（10.4min）and ⅡB（10.2min）in the recovery parameters（P0.05）.Conclusions When administered the maintenance doses of cisatracurium after rocuronium, the maximum block degree is enhanced and the clinical duration is prolonged.But the recovery index is similar in all groups.