在老年人麻醉中异氟烷对米库氯胺临床药效的影响

目的观察研究0.7%异氟烷复合异丙酚和瑞芬太尼静脉麻醉下对米库氯胺临床药效学的影响,为实际麻醉中使用静吸复合麻醉用药提供临床依据。方法选择全麻择期手术老年患者40例,ASA分级Ⅰ~Ⅱ级。将患者随机分为两组,每组20例,随机分成异氟烷组（Ⅰ组）,异丙酚组（Ⅱ组）。麻醉诱导后,Ⅰ组使用静脉输注异丙酚2~5 mg/（kg·h）,瑞芬太尼2μg/ml血浆靶控输注,并维持呼出末异氟烷浓度为1MAC（浓度：1.2%）;Ⅱ组使用静脉麻醉,用异丙酚4~10 mg/（kg·h）静脉输注,瑞芬太尼4μg/ml血浆靶控输注维持麻醉。以上指标稳定5分钟后,静脉注入米库氯胺0.15 mg/kg。选用TOF-Watch SX（Organon）加速度肌松监测仪进行肌松监测。观察以下指标：起效时间,作用时间,恢复指数,维持T1为1~10%时肌松药的泵入速度。结果静脉注入米库氯胺0.15 mg/kg后,Ⅰ组和Ⅱ组的起效时间分别是（102.1±21.8）s和（96.9±25.7）s（P〉0.05）,作用时间分别是（26.1±8.3）min和（18.7±7.5）min,维持90%~99%颤搐抑制所需米库氯胺的泵注速度分别为（6.25±1.78）μg/（kg·min）和（8.41±1.81）μg/（kg·min）,恢复指数分别为（10.13±3.82）min和（7.22±2.51）min。结论在临床麻醉过程中异氟烷可以显著增强米库氯胺的临床肌松药时效,并且减少维持90%~99%肌松所需的泵入速度。

The study of influence of isoflurane on pharmacodynamics of mivacurium chloride for elderly patients in anesthetic

Objective： To investigate the pharmacodynamics effects of 0. 7% isoflurane and propofol and remifentanil under intravenous anesthesia on mivacurium chloride to provide evidence for clinical rational drug use. Methods： Sixty ASAⅠ-Ⅱpatients under general anesthesia were randomly divided into two groups of 20 patients,namely,isoflurane group（ Group Ⅰ） and propofolum group（ GroupⅡ）. Laryngeal mask was applied for mechanical ventilation without the aid of muscle relaxants. In Group I,the patients were given intravenous infusion with 2 ~ 5mg /（ kg·h） propofol and 2μg / ml remifentanil, plasma target-controlled,and the anesthesia was maintained by continuous end exhaling 1MAC sevoflurane（ density： 1. 2%）. In Group II,the patients were given intravenous infusion with 4 ~ 10mg /（ kg·h） propofol and 4μg / ml remifentanil,plasma target-controlled,and the anesthesia was maintained. After the above mentioned index were stabilized for 5 minutes,mivacurium chloride（ 0. 15mg / kg） was intravenously infused. Before the administration of muscle relaxant,electrode was adjusted to maintain the value of TOF at 100%. After completing the adjustment of muscle relaxation monitor,TCI was started to record TOF and the following index was observed：（ 1） onset time： the time between the completion of the administration of muscle relaxant and approaching of maximum muscle relaxants,action time： the time between the completion of the administration of muscle relaxant and the recovery of T1 to 25%,（ 3） recovery index： the time between the recovery of T1 to 25% and to 75%,and（ 4） the pumping speed for 1% ~ 10% muscle relaxants in the maintenance of T1. Results： After mivacurium chloride（ 0. 15mg / kg） was intravenously infused,the onset time for Group ⅠandⅡwas（ 102. 1 ± 21. 8） and（ 94. 9 ±25. 7） s respectively（ P 0. 05）; the action time was（ 26. 1 ±8. 3） and（ 18.7 ±7. 5） min respectively; the pumping speed for mivacurium chloride to maintain 90% ~ 99% twitch inhibition was（ 6. 25 ± 1. 78） μg /（ kg·min） and（ 8. 41 ± 1. 81） μg /（ kg·min） respectively; the recovery index was（ 10. 13 ± 3. 82） min and（ 7. 22 ± 2. 51） min respectively. Conclusion： Isoflurane can significantly enhance clinical efficacy of muscle relaxants of mivacurium chloride and reduce the pumping speed of maintaining 90%-99% twitch inhibition.