术前预防性应用克林霉素对罗库溴铵维持时间和恢复时间的影响

目的 观察术前预防性应用克林霉素对罗库溴铵维持时间和恢复时间的影响.方法 选择北京积水潭医院2016年1~6月择期全麻行骨科手术的患者40例,按照随机数字表法随机将其分为克林霉素组和头孢替安组,每组20例.抗生素输注完成后,两组患者静脉注射咪达唑仑0.03 mg/kg、芬太尼3~4μg/kg及丙泊酚1.5~2.5 mg/kg麻醉诱导.患者意识消失后,启动加速度四个成串刺激(TOF)肌松监测.静脉注射罗库溴铵0.6 mg/kg,当TOF值为0时进行气管插管.术中维持呼气末七氟醚浓度于1.7%,根据BIS值(50±10)调节丙泊酚靶控泵入浓度.当TOF>0时追加罗库溴铵0.15 mg/kg.记录第一次追加罗库溴铵与诱导注射罗库溴铵时间间隔(T1),第二次追加罗库溴铵与第一次追加罗库溴铵的时间间隔(T2),第三次追加罗库溴铵与第二次追加罗库溴铵的时间间隔(T3);记录最后一次追加罗库溴铵后,从TOF>0到TOF≥50的时间间隔(T50).结果 克林霉素组和头孢替安组患者T1(31.2±7.6)min vs(32.2±7 min)]、T2(34.8±13.5)min vs(27.6±6.7 min)]相近,差异均无统计学意义(P>0.05);克林霉素组患者的T3为(37.8±10.5)min,比头孢替安组的T3(30.9±6.3)min延长,差异有统计学意义(P<0.05);克林霉素组患者的T50为12 min(10.5,15.5),比头孢替安组的8 min(6.8,14.3)延长,差异有统计学意义(P<0.05).结论 与预防性应用头孢替安比较,术前预防性应用克林霉素明显延长罗库溴铵的肌松维持时间和恢复时间.

Effect of preoperative application of clindamycin on the duration of action and recovery time of rocuronium

Objective To determine the effect of clindamycin on neuromuscular blockade induced by rocuroni-um compared with cefotiam. Methods From January 2016 to June 2016, forty ASAⅠorⅡpatients scheduled for or-thopedic surgeries in Beijing Jishuitan Hospital were enrolled in this study and equally randomized into the clindamycin group and the cefotiam group according to the random number table method. After the completion of antibiotic infusion, midazolam 0.03 mg/kg, fentanyl 3-4μg/kg and propofol 1.5-2.5 mg/kg were injected intravenously for anesthesia induc-tion. When patient's consciousness disappeared, accelerometer train of four stimulation (TOF) was performed to monitor neuromuscular effect. After intravenous injection of rocuronium 0.6 mg/kg, endotracheal intubation was performed when TOF was 0. Anesthesia was maintained with end-expiratory sevoflurane concentration stable at 1.7%and propofol infu-sion was target-controlled according to BIS (50 ± 10). When TOF>0, rocuronium (0.15 mg/kg) was added to maintain muscle relaxation. The times between the muscle relaxant injections and the TOFs>0 (T1, T2, T3) was recorded to re-flect the impact of antibiotics on the maintenance of muscle relaxation. The time (T50) between TOF>0 and TOF≥50 was recorded to reflect the impact of antibiotics on muscle relaxation recovery. Results There was no difference be-tween the two groups at T1 (31.2 ± 7.6) min vs (32.2 ± 7) min, P>0.05] and T2 (34.8 ± 13.5) min vs (27.6 ± 6.7) min, P>0.05]. Compared with the cefotiam group, the clindamycin group had prolonged neuromuscular blockade time at T3 (37.8±10.5) min vs (30.9±6.3) min, P<0.05]. The time of T50 in the clindamycin group was 12 min (10.5, 15.5), which was significantly longer than 8 min (6.8, 14.3) in the cefotiam group (P<0.05). Conclusion Preoperative application of clindamycin, compared with cefotiam, significantly extends the duration of action and recovery time of rocuronium.