不同剂量顺苯磺酸阿曲库铵在神经外科全麻插管反应的观察

目的：观察不同剂量顺苯磺酸阿曲库铵用于神经外科手术全麻诱导后行气管插管时的心血管反应,探讨其最佳的全麻诱导剂量.方法：将60例择期行脑部脑肿瘤手术的患者随机均分为I-III组,15～65岁,质量平均40～80kg,ASAI-III.全麻诱导均采用咪唑安定0.03～0.05mg/kg,芬太尼4μg/kg,顺苯磺酸阿曲库铵剂量分别为0.15mg/kg（S1）,0.20mg/kg（S2）,0.30mg/kg（S3）,丙泊酚1～2mg/kg.并于给药5min后行气管插管,分别记录诱导前2min（T0,基础值）、插管前1min（T1）、插管后1min（T2）,3min（T3）,5min（T4）无创血压收缩压（SBP）、舒张压（DBP）、MAP、心率（HR）的变化.结果：所有患者均于给药5min后完成气管插管,插管条件达到1级47例（78.3%）,2级13例（21.7%）.S1组患者气管插管后血流动力学较诱导前明显增高,呈一过性; S2组患者气管插管后血流动力学较诱导前轻度增高; S3组患者气管插管后血流动力学较诱导前无明显变化.结论：麻醉诱导时顺苯磺酸阿曲库铵0.3mg/kg能有效减轻气管插管引起的应激反应并能缩短气管插管起效时间,用于颅脑肿瘤手术患者可能有利于减少气管插管引起的心脑血管意外情况的发生.

Effect of different doses of cisatracurium on the stress response during tracheal intubation in patients undergoing neurosurgery

AIM：To observe the effect of cisatracurium on the stress response during tracheal intubation in patients undergoing neurosurgery and to evaluate the best dose of cisatracurium for induction.METHODS：Sixty patients scheduled for brain tumor resection were randomly assigned to 3 groups（S1,S2 and S3）.All patients were aged 15-65 years,weighed 40-80 kg and with an ASA of I-III.General anesthesia was induced by 0.03-0.05 mg/kg of midazolam,4 μg/kg of fentanyl,1-2 mg/kg of propofol and different doses of cisatracurium（0.15 mg/kg for S1,0.20 mg/kg for S2 and 0.30 mg/kg for S3）.Tracheal intubation was done 5 min later.The noninvasive blood pressure（SBP,DBP,MAP） and heart rate（HR） were recorded 2 min before induction（T0,baseline）,1 min before intubation（T1）,1,3 and 5 min after intubation（T2,T3 and T4）.RESULTS：Tracheal intubation was done 5 min after induction in all patients.Intubation score was 1 in 47 patients（78.3%） and 2 in 13 patients（21.7%）.Patients in group S1 suffered a transient significant increase of BP and HR after intubation.Patients in group S2 showed a mild increase of BP and HR after intubation.However,no hemodynamic change was seen in patients of group S3.CONCLUSION：0.3 mg/kg of cisatracurium for general anesthesia induction could alleviate the stress reponse induced by tracheal intubation and shorten the time to intubation,which is beneficial for patients undergoing brain tumor resection.