阿曲库铵靶控输注的肌松效应研究

目的：探讨七氟醚吸入麻醉或丙泊酚-瑞芬太尼全凭静脉麻醉对阿曲库铵效应室靶浓度及肌松效应的影响。方法：选择全麻下手术患者60例，随机分为丙泊酚．瑞芬太尼组（A组）及七氟醚吸入麻醉组（B组），各30例。以TOF刺激方式监测拇内收肌的收缩反应。从诱导靶浓度2μg·mL^-1开始效应室靶控输注阿曲库铵，术中调节靶浓度维持T1≤5％。记录两组阿曲库铵靶浓度的变化、总药量、麻醉时间、恢复指数、停药至TOFR为0．9的时间。结果：两组持续给药30min后阿曲库铵效应室靶浓度显著下降（P〈0．05），B组靶浓度低于A组（P〈0．05）；B组阿曲库铵期间用药量小于A组（P〈0．05），且恢复指数、停药到TOFR为0．9的时间短于A组（P〈0．05）。结论：七氟醚吸入麻醉和丙泊酚-瑞芬太尼静脉麻醉均能呈时间依赖性地降低阿曲库铵效应室靶浓度，且前者的影响明显大于后者，停药后肌松恢复更为迅速。

Neuromuscular Blockade of Atracurium by Target-controlled Infusion

Objectives： To investigate the effect of sevoflurane or propofol-remifentanil anesthesia on effect-site concentration and neuromuscular blockade effects of atracurium by target-controlled infusion. Methods： Sixty patients were randomly allocated to group A propofol-remifentanil and group B sevoflurane anesthesia. The induced target effectsite concentration of atracurium was set at 2 μg·mL^-1 and adjusted manually to maintain T1 ≤5% of the control heigh.t during operations. The following variables were recorded： target effect-site concentration, anesthesia time, total amount of atracurium, spontaneous recovery index, and the time interval from termination of TCI atracurium to recovery of TOFR to 0.9. Results： Effect-site concentration was degraded in both groups since 30 min after TCI of atracurium（P 〈 0.05）. The average dosage of atracurium and spontaneous recovery index was significant smaller in group B than in group A （P 〈 0.05）. Conclusion： Both sevoflurane and propofol-remifentanil anesthesia can reduce target effect -site concentration of atracurium by time dependence. Further, the recovery is faster in the sevoflurane anesthesia.