硫酸镁对维库溴铵神经肌肉传导的影响

目的 探讨在神经外科手术中硫酸镁对维库溴铵神经肌肉传导的影响。方法 选择ASA Ⅰ～Ⅱ级,择期全身麻醉下行颅内肿瘤占位病变切除手术的患者30例,年龄20～50岁.随机分为两组：A组（硫酸镁组）和B组（对照组）.A组于诱导前10min静脉注射40mg/kg的硫酸镁,然后以10mg/（kg）的速度持续输注直至手术结束.B组静脉注射相同容量的生理盐水.记录患者的年龄、性别、体重,手术时间,肌松起效时间[即维库溴铵开始输注至TOF=0（即插管时间）的时间],肌松维持时间[即于停药（TOF=3）至TOF恢复为25％的时间],术中维库溴铵的平均用量,记录术中的血流动力学变化,在输注硫酸镁/生理盐水前及手术结束后抽取血标本测量血清镁、钙离子浓度.结果 两组患者性别、年龄、体重、手术时间的比较,差异无统计学意义（P＞0.05）.A组肌松起效时间1.99±0.37min短于B组肌松起效时间4.08±0.38min,而肌松维持时间方面A组30.27±3.60min长于B组21.67±2.19min,维库溴铵的平均用量A组0.32±0.05μg/（kg·min）少于B组0.44±0.06μg/（kg·min）,差异有统计学意义（P＜0.05）.气管内插管后和缝皮、拔管时硫酸镁组MAP和HR均低于对照组（P＜0.05）.术前两组患者的血清镁离子浓度差异无统计学意义,术后浓度均较术前有所降低,其中对照组较术前显著降低（P＜0.01）.两组血清钙离子浓度无明显变化.结论 硫酸镁可以使维库溴铵神经肌肉传导阻滞起效时间缩短,肌松效应维持时间延长,减少肌松药维库溴铵的用量,并且可以减轻插管反应,保持血流动力学稳定,且不升高术后血清镁离子水平。

Effects of Magnesium Sulfate on Vecuronium Neuromuscular Conduction in Neurosurgery

Objective In this double-blind,randomized,placebo-controlled study,we evaluated the effects of magnesium sulfate on neuromuscular blocking agent requirements and the neuromuscular conduction of vecuronium in neurosurgery.Methods Thirty ASA Ⅰ or Ⅱ patients aged 20-50 years undergoing neurologist surgery under general anesthesia were randomly allocated to one of two groups：group A（magnesium sulfate group） and group B （control group）.Patients in groupA got an dose of 40mg/kg magnesium sulphate 10 minutes before the induction,followed by an intraoperative infusion of 10mg/（kg · h） till the suturing.Patients in group B was given the same amount of saline solution.Age,sex,weight,duration of surgery,T1 （time of vecuronium infusened to intubation time）,T2 （muscle relaxant maintenance time,recover time of TOF =3 to 25％）,intraoperative vecuronium consumption were recorded.The values of changes of mean arterial pressure（MAP）,heart rate（H-R） were observed：Blood samples were collected before MgSO4/saline infusion and at the end of operation to determine serum magnesium and calcium levels.Haemodynamic changes and other responses during induction were also recorded.Results There was no significant difference in sex,age,body weight,operative time.Compared with groups A,The average vecuronium consumption was lower in group B（P ＜ 0.05）.Muscles loose effect-acting period in group A was shorter,and muscle loose maintaining in group B was prolonged.There was no significant difference in serum magnesium ion concentration.（P ＜ 0.01）.Two Serum calcium ion concentration in two groups had no obvious change.Conclusion Magnesium sulfate can make vecuronnium ammonium neuromuscular conduction blockade effect-acting period shorter,muscle loose effect maintain prolonged,reduce muscle relaxant dosage,and maintain hemodynamic stability,and don＇t increase the postoperative serum magnesium levels.