天津医药

天津医药 ›› 2015, Vol. 43 ›› Issue (12): 1450-1453.doi: 10.11958/j.issn.0253-9896.2015.12.028

• 药物临床观察 • 上一篇    下一篇

预先静注布托啡诺与地佐辛抑制依托咪酯所致肌阵挛效应的比较

张婧，刘玲，吕国义△   

  1. 天津医科大学第二医院麻醉科（邮编300211）
  • 收稿日期:2015-05-05 修回日期:2015-06-30 出版日期:2015-12-15 发布日期:2015-12-11
  • 通讯作者: △通讯作者E-mail：lvguoyiys@126.com E-mail:zhangjing0391@sina.com
  • 作者简介:张婧（1989），女，硕士在读，主要从事临床麻醉研究

Comparison of the effects of intravenous pre-treatment of Butorphanol and Dezocine on prevention of Etomidate-induced myoclonus

ZHANG Jing, LIU Ling，LYU Guoyi△   

  1. Department of Anesthesiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
  • Received:2015-05-05 Revised:2015-06-30 Published:2015-12-15 Online:2015-12-11
  • Contact: △Corresponding Author E-mail：lvguoyiys@126.com E-mail:zhangjing0391@sina.com

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摘要： 目的比较布托啡诺与地佐辛对依托咪酯所致肌阵挛的抑制作用。方法拟在全身麻醉下行择期手术的患者150 例，ASA 分级Ⅰ或Ⅱ级，年龄40~65 岁，体质指数（BMI）20~25 kg/m²，将患者随机分为A、B、C 3 组（n= 50），A 组预先静脉滴注布托啡诺15 μg/kg，B 组给予地佐辛0.1 mg/kg，C 组给予等量生理盐水，给药时间均为30 s，2 min 后各组均静脉注射依托咪酯0.3 mg/kg（1 min 注射完毕），即刻开始观察并记录每组肌阵挛发生的次数及强度，时间均为2 min。同时记录麻醉诱导前（T0）、给予实验药物后2 min（T1）、静脉注射依托咪酯后2 min（T2）各时点每组患者的平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）和脑电双频谱指数（BIS）值。并于T0及气管插管后5 min（T3）测定血钾浓度。结果3 组发生肌阵挛的阳性率分别为12%、22%、74%。A、B 2 组肌阵挛阳性率及强度较C 组明显降低，差异有统计学意义（P < 0.05）；A、B 两组比较差异无统计学意义（P > 0.05）；T3与T0时比较，无肌阵挛（0 级）及发生1 级与2 级肌阵挛的患者血钾浓度无明显变化（P > 0.05）；发生严重肌阵挛的患者（3 级）血钾浓度明显升高（P < 0.05）；T0、T1与 T2时刻3 组患者的MAP、HR、SpO2及BIS 值差异无统计学意义（P > 0.05）。结论预先静脉注射布托啡诺15 μg/kg 或地佐辛0.1 mg/kg 2 min 后均能有效抑制静脉注射依托咪酯引起的肌阵挛，且二者对循环和呼吸系统的影响无明显差异。

关键词: 布托啡诺, 依托咪酯, 肌阵挛, 受体, 阿片样, κ, 地佐辛

Abstract: Objective To compare the inhibitory effects of Butorphanol and Dezocine on Etomidate-induced myoclo⁃ nus. Methods A total of 150 patients with ASA physical statusⅠorⅡ, aged 40-65 yr, with body mass index (BMI) of 20- 25 kg/m², scheduled for elective operations under general anesthesia, were included in this study. Patients were randomly al⁃ located into three groups (A, B and C) with 50 patients in each group. Group A was given intravenous Butorphanol 15 μg/kg for 30 s, group B was given Dezocine 0.1 mg/kg and group C was given equal volume of saline. After 2 min, etomidate 0.3 mg/kg was administrated to three groups. The occurrence and severity of myoclonus were recorded for 2 min after administration of Etomidate. The mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO2) and Bispectral index (BIS) were recorded at the time points before induction (T0), 2 min after the experimental drug treatment (T1), and 2 min after Etomi⁃ date treatment (T2). At the same time, the concentration of serum potassium was determined at T0 and 5 min after endotrache⁃ al intubation (T3) respectively. Results The positive incidences of myoclonus were 12% in group A, 22% in group B and 74% in group C, respectively. Compared with group C, the positive incidence rates of myoclonus and myoclonus scales were significantly lower in group A and group B (P < 0.05), but no significant difference between group A and group B (P > 0.05). Compared with T0, there was no significant difference in the potassium concentration between patients without myoclonus (grade 0) and patients with myoclonus (grade 1 and grade 2) at T3 (P > 0.05). There was a significant increase in potassium concentration in patients with grade 3 (P < 0.05). There were no significant differences in MAP, HR, SpO2 and BIS values at T0, T1 and T2 between three groups of patients (P＞0.05). Conclusion Pre-treatment of Butorphanol (15 μg/kg) or Dezocine (0.1 mg/kg) can reduce the Etomidate-induced myoclonus. At the same time, both therapies show no different effects on cir⁃ culation and respiration system.

Key words: Butorphanol, Etomidate, myoclonus, receptors, opioid, kappa, Dezocine