全凭静脉麻醉中持续输注顺苯磺酸阿曲库铵的药效学观察

目的探讨全凭静脉麻醉中持续输注顺苯磺酸阿曲库铵（Cis）的药效学特点。方法选择择期手术患者60例，随机分成四组，每组各15例。Ⅰ、Ⅱ、Ⅲ组麻醉诱导后持续泵注Cis1．0、2．0、3．0ug／（kg·min），Ⅳ组间断静脉注射Cis 0．1mg／kg。术中采用四个成串（TOF）刺激模式监测肌松效果。记录各组患者术中TOF值（TOFR）及停药后TOFR从0恢复到25％的时间（临床作用时间），从0恢复到75％和从0恢复到90％的时间（体内作用时间）以及从25％恢复到75％的时间（恢复指数）。结果Ⅰ、Ⅱ组cis用药量（59．1±9．6）、（116．7±11．5）ug／kg]比Ⅲ组（174．9±23．1）ug／kg]和Ⅳ组（177．2±20．4）ug／kg]显著减少（P〈0．01），而Ⅲ、Ⅳ组Cis用药量相近（P〉0．05）；术中Ⅰ、Ⅱ、Ⅲ组患者TOFR的最大值（TOFRmax）（18．5±3．6）％、（6．4±2．7）％、0]明显小于Ⅳ组（25．0±0．0）％]（P〈0．01）；临床作用时间和体内作用时间均短于Ⅳ组（P〈0．01）；肌松恢复指数各组间比较差异无统计学意义（P〉0．05）。随着Cis剂量的增加，各组TOFRmax相应减小（P〈0．01），临床作用时间和体内作用时间相应延长（P〈0．05）。结论静脉持续输注Cis无药物蓄积作用，恢复指数无延长，肌松恢复时间更短。

Observation of pharmacodynamics characteristics of continuously infused cisatracurium besylate during total intravenous anesthesia

Objective To investigate the pharmacodynamics characteristics of continuously infused cisatracurium besylate during total intravenous anesthesia. Methods Sixty ASA Ⅰ - Ⅱ patients undergoing elective oromaxillo-facial region surgeon were randomly divided into 4 groups. 1.0, 2.0, 3.0 ug/ （kg·min） of cisatracurium besylate was continuously infused differently in group Ⅰ, group Ⅱ and group Ⅲ, and 0.1 mg/kg of cisatracurium besylate was injected interruptedly into group Ⅳ after anesthesia induction. Neuromuscular function was assessed using an accelerometer with train-of-four （TOF） stimulation, the maximum depression of T1 and times to T1 recovered to 25%（the clinic time）, 75%, 90%（the vivo time） were noted. The recovery index （time of TI recovery from 25% to 75%） was also calculated. Results The drug consumptions of cisatraeurium besylate in group Ⅰ and group Ⅱ were diminished than those in group Ⅲ and group Ⅳ （59.1 ±9.6）, （116.7 ± 11.5）ug/kg vs （174.9±23.1）, （177.2±20.4）ug/kg]（P〈0.01）, and group Ⅲ and group Ⅳ were nearly （P〉 0.05）. The maximum depression of T1, the clinic time and the vivo time in group Ⅰ, Ⅱ, Ⅲ were smaller than those in group Ⅳ （18.5 ±3.6）%, （6.4 ± 2.7）%, 0 vs （25.0 ± 0.0）% ]（P 〈 0.01 ）, but there were no significant differences in recovery index in 4 groups. The maximum depression was diminished （P 〈 0.01 ） and the clinic time and the vivo time were prolonged （P 〈 0.05 ） with the increase of the dosage of cisatraeurium besylate in group Ⅰ, Ⅱ, Ⅲ. Conclusions with no cumulative effect, the duration of recovery of muscle relaxation is shortened and the recovery index of continuously infused cisatraeurium besylate is prolonged. It indicates that the cisatracurium besylate is suitable for the continuously infusion for surgeon patients.