天津医药

• 药物临床观察 •    

顺式阿曲库铵在室温放置不同时间对神经肌肉阻滞时效的影响

李春莲1,于泳浩2   

  1. 1. 天津市第三医院麻醉科
    2. 天津医科大学总医院麻醉科
  • 收稿日期:2011-12-28 修回日期:2012-06-22 出版日期:2012-12-15 发布日期:2012-12-15
  • 通讯作者: 李春莲

Effects of cisatracurium at room temperature for different time on the course of neuromuscular block

2   

  • Received:2011-12-28 Revised:2012-06-22 Published:2012-12-15 Online:2012-12-15

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摘要： 摘要 目的: 比较顺式阿曲库铵在室温下放置不同时间对神经肌肉阻滞时效的影响。方法: 择期全麻腹部手术患者60例，年龄20~60岁，体重45~85kg，体重指数（BMI）20~30，ASAⅠ~Ⅱ级，随机分为四组，每组各15例。Ⅰ组将顺式阿曲库铵（葛兰素史克公司，5 mL含顺式阿曲库铵 10mg）在室温下（22~24℃）放置4h；Ⅱ组将顺式阿曲库铵用0.9%氯化钠液稀释一倍后在室温下放置4h；Ⅲ组将顺式阿曲库铵在室温下放置12h；Ⅳ组为对照组，是将顺式阿曲库铵置于2~8℃冰箱中保存。所有患者均静脉注射咪达唑仑0.05mg/kg、芬太尼1~2μg/kg和丙泊酚1.5~2mg/kg行麻醉诱导，当患者意识消失后，启动加速度计肌松监测仪定标，完成定标后开启TOF模式，于5s内快速静脉注射顺式阿曲库铵0.15mg/ kg，待下颌松弛后置入单管喉罩，确定喉罩位置正确后接麻醉机行机械通气。继之以丙泊酚6~10mg/（kg．h）维持麻醉，并根据需要间断静脉注射芬太尼1~2μg/kg。记录肌松起效时间（注肌松药完毕至T1降至0的时间）、完全肌松时间（T1从消失到出现的时间）及肌松维持时间（起效至T4/T1恢复到25%的时间）。结果： Ⅰ组与对照组间肌松起效时间、完全肌松时间及肌松维持时间无明显差异（P>0.05）；Ⅱ组、Ⅲ组分别与对照组和Ⅰ组比较，完全肌松时间和肌松维持时间均缩短（P<0.05）。结论： 顺式阿曲库铵在室温下放置4h，其临床时效变化不明显。在室温下放置12h或用0.9%氯化钠液稀释一倍后在室温下放置4h，其临床时效明显减低。

关键词: 顺式阿曲库铵, 神经肌肉阻滞, Hofmann代谢

Abstract: Abstract Objective: Compare the effects of cisatracurium at room temperature on the course of neuromuscular blockade. Methods Sixty patients undergoing elective abdominal surgery with general anesthesia were randomly assigned to one of four groups (n=15 each). In group Ⅰ, cisatracurium was kept in room temperature(22~24℃）for 4 hours.In group Ⅱ, cisatracurium was diluted two times with 0.9%sodium chloride，then it was kept in room temperature for 4 hours.In group Ⅲ, cisatracurium was kept in room temperature for 12 hours.In group Ⅳ（control group）, cisatracurium was kept in fridge at 2~8℃ before using. Anesthesia was induced with midazolam 0.05mg/kg, fentanyl 1~2μg/kg and propofol 1.5~2mg/kg intravenously. Laryngeal mask was inserted after cisatracurium 0.15 mg/ kg . Anesthesia was maintained with propofol 6~10mg/（kg．h）. Neuromuscular function was assessed by accelerography. TOF stimulation of ulnar nerve was used. The onset time,recovery of first twitch(T1) and recovery of TOF 25% were recorded. Results There was no significant difference in onset time,recovery of first twitch and recovery of TOF 25% between group Ⅰ and control group. In group Ⅱ and group Ⅲ, recovery of first twitch(T1) and recovery of T4/T1 25% were significantly shoter than control group and group Ⅰrespectively. Conclusion Cisatracurium was kept in room temperature for 4h,which has little effects on the course of neuromuscular blockade. However, the clinical duration of cisatracurium was siginificantly shorter when it was kept in room temperature for 12h or when it was diluted two times with 0.9%sodium chloride and then kept in room temperature for 4h.

Key words: Cisatracurium, Neuromuscular block, Hofmann elimination