中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2010年
3期
257-261
,共5页
吴新民%李玲%刘毓和%张兰霞
吳新民%李玲%劉毓和%張蘭霞
오신민%리령%류육화%장란하
阿曲库铵%剂量效应关系,药物%组胺
阿麯庫銨%劑量效應關繫,藥物%組胺
아곡고안%제량효응관계,약물%조알
Atracurium%Dose-response relationship,drug%Histamine
目的 比较全麻诱导期间不同保存条件下顺阿曲库铵和阿曲库铵的药效学及其对组胺释放的影响.方法 择期全麻手术患者45例,ASA Ⅰ或Ⅱ级,年龄16-71岁,随机分为3组(n=15):阿曲库铵冷藏组(ATR冷藏组)、顺阿曲库铵冷藏组(CIS冷藏组)和顺阿曲库铵常温组(CIS常温组).靶控输注异丙酚血浆靶浓度3μg/ml和瑞芬太尼效应室靶浓度3～5 ng/ml行麻醉诱导.ATR冷藏组静脉注射冷藏保存的阿曲库铵0.75 mg/kg,CIS冷藏组和CIS常温组分别静脉注射冷藏或室温保存的顺阿曲库铵0.15 mg/kg.使用肌松监测仪,采用单次颤搐刺激(频率0.1Hz,刺激持续时间0.2ms),测定刺激前臂尺神经拇内收肌的加速度.记录肌颤搐最大抑制程度、起效时间、作用时间和恢复指数.肌颤搐抑制达最大抑制时行气管插管,机械通气,评价气管插管条件.于麻醉诱导前(T0)、给予静脉全麻药后2min(T1)、给予肌松药后2min(T2)和5min(T3)时,记录MAP和HR,观察皮肤情况,同时采集桡动脉血样2ml,采用酶联免疫吸附法测定血浆组胺浓度.结果 CIS冷藏组和ATR冷藏组肌颤搐抑制均可达100%,CIS常温组仅53.33%的患者肌颤搐抑制最大达90%.与ATR冷藏组比较,CIS冷藏组起效时间延长,作用时间缩短(P<0.05),恢复指数差异无统计学意义(P>0.05);与CIS冷藏组比较,CIS常温组起效时间延长,作用时间缩短(P<0.05),恢复指数差异无统计学意义(P>0.05).ATR冷藏组和CIS冷藏组的气管插管条件优于CIS常温组(P<0.05).两组间不同时点血浆组胺浓度、MAP和HR比较差异无统计学意义(P>0.05);与T0时比较,ATR冷藏组T2,3时血浆组胺浓度升高,T1～3时MAP降低,CIS冷藏组T1～3时MAP降低(P<0.05).各组患者皮肤均未发现任何变化.结论 与冷藏保存的阿曲库铵相比,冷藏保存的顺阿曲库铵肌松作用强而起效较慢,作用时间较短,不引起组胺释放,可安全地应用于全身麻醉.但该药在室温下保存120d后,药效稳定性较差.
目的 比較全痳誘導期間不同保存條件下順阿麯庫銨和阿麯庫銨的藥效學及其對組胺釋放的影響.方法 擇期全痳手術患者45例,ASA Ⅰ或Ⅱ級,年齡16-71歲,隨機分為3組(n=15):阿麯庫銨冷藏組(ATR冷藏組)、順阿麯庫銨冷藏組(CIS冷藏組)和順阿麯庫銨常溫組(CIS常溫組).靶控輸註異丙酚血漿靶濃度3μg/ml和瑞芬太尼效應室靶濃度3～5 ng/ml行痳醉誘導.ATR冷藏組靜脈註射冷藏保存的阿麯庫銨0.75 mg/kg,CIS冷藏組和CIS常溫組分彆靜脈註射冷藏或室溫保存的順阿麯庫銨0.15 mg/kg.使用肌鬆鑑測儀,採用單次顫搐刺激(頻率0.1Hz,刺激持續時間0.2ms),測定刺激前臂呎神經拇內收肌的加速度.記錄肌顫搐最大抑製程度、起效時間、作用時間和恢複指數.肌顫搐抑製達最大抑製時行氣管插管,機械通氣,評價氣管插管條件.于痳醉誘導前(T0)、給予靜脈全痳藥後2min(T1)、給予肌鬆藥後2min(T2)和5min(T3)時,記錄MAP和HR,觀察皮膚情況,同時採集橈動脈血樣2ml,採用酶聯免疫吸附法測定血漿組胺濃度.結果 CIS冷藏組和ATR冷藏組肌顫搐抑製均可達100%,CIS常溫組僅53.33%的患者肌顫搐抑製最大達90%.與ATR冷藏組比較,CIS冷藏組起效時間延長,作用時間縮短(P<0.05),恢複指數差異無統計學意義(P>0.05);與CIS冷藏組比較,CIS常溫組起效時間延長,作用時間縮短(P<0.05),恢複指數差異無統計學意義(P>0.05).ATR冷藏組和CIS冷藏組的氣管插管條件優于CIS常溫組(P<0.05).兩組間不同時點血漿組胺濃度、MAP和HR比較差異無統計學意義(P>0.05);與T0時比較,ATR冷藏組T2,3時血漿組胺濃度升高,T1～3時MAP降低,CIS冷藏組T1～3時MAP降低(P<0.05).各組患者皮膚均未髮現任何變化.結論 與冷藏保存的阿麯庫銨相比,冷藏保存的順阿麯庫銨肌鬆作用彊而起效較慢,作用時間較短,不引起組胺釋放,可安全地應用于全身痳醉.但該藥在室溫下保存120d後,藥效穩定性較差.
목적 비교전마유도기간불동보존조건하순아곡고안화아곡고안적약효학급기대조알석방적영향.방법 택기전마수술환자45례,ASA Ⅰ혹Ⅱ급,년령16-71세,수궤분위3조(n=15):아곡고안랭장조(ATR랭장조)、순아곡고안랭장조(CIS랭장조)화순아곡고안상온조(CIS상온조).파공수주이병분혈장파농도3μg/ml화서분태니효응실파농도3～5 ng/ml행마취유도.ATR랭장조정맥주사랭장보존적아곡고안0.75 mg/kg,CIS랭장조화CIS상온조분별정맥주사랭장혹실온보존적순아곡고안0.15 mg/kg.사용기송감측의,채용단차전휵자격(빈솔0.1Hz,자격지속시간0.2ms),측정자격전비척신경무내수기적가속도.기록기전휵최대억제정도、기효시간、작용시간화회복지수.기전휵억제체최대억제시행기관삽관,궤계통기,평개기관삽관조건.우마취유도전(T0)、급여정맥전마약후2min(T1)、급여기송약후2min(T2)화5min(T3)시,기록MAP화HR,관찰피부정황,동시채집뇨동맥혈양2ml,채용매련면역흡부법측정혈장조알농도.결과 CIS랭장조화ATR랭장조기전휵억제균가체100%,CIS상온조부53.33%적환자기전휵억제최대체90%.여ATR랭장조비교,CIS랭장조기효시간연장,작용시간축단(P<0.05),회복지수차이무통계학의의(P>0.05);여CIS랭장조비교,CIS상온조기효시간연장,작용시간축단(P<0.05),회복지수차이무통계학의의(P>0.05).ATR랭장조화CIS랭장조적기관삽관조건우우CIS상온조(P<0.05).량조간불동시점혈장조알농도、MAP화HR비교차이무통계학의의(P>0.05);여T0시비교,ATR랭장조T2,3시혈장조알농도승고,T1～3시MAP강저,CIS랭장조T1～3시MAP강저(P<0.05).각조환자피부균미발현임하변화.결론 여랭장보존적아곡고안상비,랭장보존적순아곡고안기송작용강이기효교만,작용시간교단,불인기조알석방,가안전지응용우전신마취.단해약재실온하보존120d후,약효은정성교차.
Objective To evaluate and compare the histamine-releasing,potencies of cis-atracurium and atracurium during induction of general anesthesia.Methods Forty-five ASA Ⅰ or Ⅱ patients aged 16-71 yr undergoing elective surgery under general anesthesia were randomly divided into 3 groups (n=15 each):group Ⅰcis-atracurium (stored at 4-8℃)(group CIS1);groupⅡcis-atracurium (stored at room temperature)(group CIS2) and group Ⅲ atracurium (stored at 4-8℃)(group ATR).Anesthesia Was induced with TCI of propofol (Cp 3 μg/ml) and remifentanil (Ce 3-5 ng/ml).A bolus of cis-atracurium 0.15 mg/kg or atracurium 0.75 mg/kg Was given iv over 5-10 s as soon as the patients lost consciousness.Neuro-muscular block was monitored with TOF-Watch(R) SX(Organon,the Netherlands).Single stimulation (0.1 Hz) was apphed to the ulna nerve at wrist.The maximal degree of N-M block,onset time,duration of action and recovery index were recorded.The patients were intubated and mechanically ventilated when N-M block reached the maximal degree.The intubation condition Was evaluated.MAP and HR were continuously monitored.Changes in skin were scored (0=no change,Ⅰ=flushed>120 s,Ⅱ=erytbema,Ⅲ=urticaria).Blood samples were obtained before (T0,baseline),at 2 min after induction of anesthesia with TCI of propofol and remifentanil (T1) and 2 and 5 min after CIS/ATR administration (T2,T3) for determination of plasma histamine concentration using enzymatically amplified immunoassay.Results The onset time was significantly longer and the duration of action was significantly shorter in group CIS1 than in group ATR.The maximal degree of N-M block was 100%and the intubation condition was excellent in group CIS1 and ATR.There wag no significant difference in the recovery index between group CIS1 and ATR.The onset time was significantly longer and duration of action shorter in group CIS2 than in group CIS1.There was no significant difference in recovery index between group CIS1 and CIS2.There was no significant change in plasma histamine concentration at T1-3 as compared with the baseline at T0 in group CIS1 but plasma histamine concentration was significantly increased at T2,3 in group ATR.MAP was significantly decreased after induction of anesthesia with propofol and remifentanil,but CIS and ATR did not significantly change MAP.Conclusion The onset time is longer and duration of action is shorter after cis-atracurium than afar atracurium.The N-M block induced by cis-atracurium is significantly attenuated if stored at the room temperature.Cis-atracurium does not cause histamine release.
