老年患者顺式阿曲库铵不同用药方式的作用时效比较

目的观察顺式阿曲库铵两种不同用药方式在老年患者腹部手术中的肌松效应及对恢复速度的影响。方法 32例ASAⅡ～Ⅲ级择期老年腹部手术患者,随机分为两组（Ⅰ组和Ⅱ组,每组16例）。麻醉诱导均采用咪唑安定、异丙酚及芬太尼,以瑞芬太尼和异丙酚维持麻醉。Ⅰ组术中每当T1恢复到10%时单次静脉推注0.05～0.1mg/kg顺式阿曲库铵,Ⅱ组当T1恢复到5%时开始微量泵输注顺式阿曲库铵（2～3μg/（kg.min））,两组维持肌松T1〈10%,直到手术关腹后停止给药。术中记录肌松作用时间、最后注药或停药距T1为25%时间、恢复指数,并计算单位时间用药量。结果两组肌松效应和恢复指数相比均无统计学差异（P〉0.05）,单位时间用药量亦无统计学差异（P〉0.05）;最后注药或停药距T1为25%时间,Ⅰ组长于Ⅱ组（P〈0.05）。结论顺式阿曲库铵用于老年患者麻醉可产生良好的肌松效应,术中持续微量泵注射顺式阿曲库铵较为合理。

Comparison of Different Medication Ways of Cis-atracurium in Elderly Patients

Objective To investigate the pharmacodynamic profiles and effects on the recovery rate of two different medication methods using cis-atracurium in abdominal surgery of elder patients.Methods Thirty-two elder patients of ASA Ⅱ to Ⅲ were divided into two groups(Ⅰand Ⅱgroup).Intraoperative remifentanil and propofol were used to maintain anesthesia and the dosages was adjusted according to the value of CSI.SX acceleration instrument was applied for monitoring muscle relaxation.During surgery,single intravenous injection of muscle relaxant and trachea intubation was performed when T1 being zero.In GroupⅠ,single intravenous injection of cis-atracurium 0.05 to 0.1mg/kg was performed when T1 restored to 10% to keep T1 less than 10%.In Group Ⅱ,injection of cis-atracurium of 2～3μg/(kg·min) using micro-injection pump was started when T1 restored to 5% to keep T1 less than 10%.The injection action was repeated until the abdomen was closed.Muscle relaxation time,the last injection or withdrawal from TOF = 1 time,recovery index(TOF =1 to 4 time) were recorded and the dosage in unit of time was calculated.Results Muscle relaxation effects and recovery index showed no significant difference in time(P>0.05);dosage of time unit was no significant difference between two groups(P>0.05).The time of last injection or withdrawal to the TOF=1 of the group Ⅰ was longer than that of group Ⅱ(P<0.05).Conclusion Good muscle relaxant effect can be achieved when cis-atracurium is used in surgery in older patients.It is more reasonable to use micropump to inject cis-atracurium.