七氟醚和异氟醚对罗库溴铵量-效关系的影响

目的探讨七氟醚和异氟醚呼气末浓度对罗库溴铵量-效关系的影响。方法 56例择期全身麻醉行五官科手术的患者随机分成7组,七氟醚组（S1-S3,七氟醚呼气末浓度分别维持0.4 MAC、0.7 MAC、1.0 MAC）、异氟醚组（I1-I3,异氟醚呼气末浓度分别维持0.4 MAC、0.7 MAC、1.0 MAC）及P组（异丙酚麻醉组,输注速度4-10mg.kg-1.h-1）,每组8例。所有患者插管后均持续输注瑞芬太尼0.1-0.2μg.kg-1.min-1,S1-S3组和I1-I3组七氟醚和异氟醚呼气末浓度稳定40 min后注入罗库溴铵0.6 mg.kg-1,P组在输注异丙酚40 min后注入罗库溴铵0.6 mg.kg-1,用TOF-Watch SX肌松监测仪进行拇内收肌肌松监测,记录罗库溴铵的起效时间（T0）;临床作用时间（T25）;恢复指数（TI）。结果与P比较,S2、S3、I2、I3起效时间明显缩短（P〈0.05）,临床作用时间和恢复指数明显延长（P〈0.05）。与S2比较S3起效时间明显缩短,临床作用时间和恢复指数明显延长（P〈0.05）;与I2比较I3起效时间明显缩短,临床作用时间和恢复指数明显延长（P〈0.05）。结论 0.4MAC呼气末浓度七氟醚或异氟醚不能强化罗库溴铵的临床药效,0.7MAC以上七氟醚或异氟醚能明显强化罗库溴铵的临床药效,并有明显剂量依赖趋势。

The effects of dose response of sevoflurane and isoflurane on pharmacodynamics of Rocuronium

Objective：To observe the effects of dose response of sevoflurane and isoflurane on pharmacodynamics of Rocuronium.Methods： Fifty six ASA classⅠ~Ⅱ otorhinolaryngology patients were randomly allocated to group P（maintained by propofol）;group S1,S2,S3 and I1,I2,I3 end-expiratory concentrations of sevoflurane and isoflurane were maintained by 0.4MAC,0.7MAC and 1MAC respectively.Anesthesia was induced by midazolam,propofol and fentainyl and maintained by propofol and a continuous infusion of 0.1-0.2μg·kg-1·min-1 in group P,In group S1,S2,S3 and I1,I2,I3,the anesthesia was maitained by sevoflurane and isoflurane inhalation of 0.4MAC,0.7MAC and 1MAC respectively and a continuous infusion of remifentainl 0.1-0.2μg·kg-1·min-1 altogether.A bolus dose of Rocuronium of 0.6 mg·kg-1 was administered after end-expiratory concentration of sevoflurane or isoflurane was stable for 40 min.Acceleromyography（TOF-Watch SX） and train-of-four（TOF） stimulation of the ulnar nerve were used（2 Hz every 15 s）,the onset time,clinical during time and recovering index was recorded.Results： The onset time was significantly shorter in S2,S3 and I2,I3 group than that in group P（P0.05）,and the during time and recover index were significantly longer in group S2,S3 and I2,I3 than that in group P（P0.05）.Compared to S2,the onset time was significantly shorter and the during time and recover index were significantly longer in S3 and I3 in group（P0.05）.Conclusion： More than 0.7MAC end-expiratory concentration of sevoflurane can strengthen pharmacodynamics rocuronium and with the concentration of sevoflurane inhalation rise,the pharmacodynamics of rocuronium becomes stronger.