神经外科术中核磁(iMRI)对持续输注顺苯磺阿曲库铵肌松作用的影响

目的观察神经外科术中行核磁检查（iMRI）对顺苯磺阿曲库铵肌松作用的影响。方法采用前瞻、随机、对照研究。选择40例ASAⅠ～Ⅱ级、择期行开颅手术患者,随机分为术中核磁检查组（iMRI组）和对照组,每组20例。采用加速度仪四个成串刺激（TOF）,监测顺苯磺阿曲库铵肌松作用的起效、维持及恢复。麻醉诱导后给予顺苯磺阿曲库铵0.15mg/kg,TOF值T1为0时静脉输注顺苯磺阿曲库铵松0.05～0.10mg/（kg·h）,维持T1在0～5%;关闭硬脑膜时停止顺苯磺阿曲库铵输注,记录T1恢复25%、TOF恢复25%、75%、90%的时间,手术结束时间、回神经外科ICU（NICU）时间及两组顺苯磺阿曲库铵用药量、用药时间。结果两组患者的一般情况、顺苯磺阿曲库铵用药量、用药时间、T1恢复25%时间、肌松恢复指数（TOF75%～TOF25%）、手术结束时间和返回SICU时间均无显著性差异;iM-RI组患者体温逐渐升高,而对照组体温下降,开颅后3h两组间比较存在显著性差异（P〈0.05）,并维持至手术结束分别为（37.14±0.39）℃和（35.58±0.83）℃。结论术中行核磁检查可使患者体温升高,但对于顺苯磺阿曲库铵肌松恢复无显著影响。

The effects of iMRI on muscle relaxation of cisatracurium in neurosurgery

Objective To investigate the effect of iMRI on the pharmcokinetics of Cisatracurium.Methods Forty patients undergoing elective craniotomy with ASA grade Ⅰ～Ⅱ were randomized and blinded into two Groups：Group iMRI （performing operation with MRI, n=20） and Control Group （no MRI, n=20）.The onset time, duration and recovery of cisatracurium were monitored by TOF （train of four stimulations）.After intubation, cisatracurium 0.15mg/kg were injected intravenously, then maintained the T1 of TOF 0～5% by the rate of 0.05～0.10 mg/（kg·h）.The infusion of cisatracurium was ended when the meninges were closed.The time of T1 to 25% and TOF recovery to 25%,75%, 90% and the duration of op-eration were recorded respectively.The total dosage of cisatracurium was recorded.Results There was no significant dif-ference between the two groups in the dosage of cisatricurium, T1 25% and recovery parameters（TOF 25%～TOF 75%）.The body temperature was gradually elevated in Group iMRI, but decreased in the Control Group.There was statistically signif-icant difference at 3h after craniotomy and the difference maintained to the end of the operation （37.14 ±0.39）℃ vs （35.58±0.83）℃].Conclusions The body temperature of the patients undergoing craniotomy with IMRI is elevated, but it has no effect on the neuromuscular recovery of cisatracurium.