中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2008年
6期
537-539
,共3页
王莹恬%沈浩%张曦%李士通
王瑩恬%瀋浩%張晞%李士通
왕형념%침호%장희%리사통
阿曲库铵%神经肌肉阻滞%面部肌肉%拇内收肌
阿麯庫銨%神經肌肉阻滯%麵部肌肉%拇內收肌
아곡고안%신경기육조체%면부기육%무내수기
Atracurium%Neuromuscular blockade%Facial muscles%Adductor pollicis muscle
目的 比较不同剂量顺式阿曲库铵对患者拇内收肌与眼轮匝肌的肌松效应.方法 全麻患者25例,ASA Ⅰ或Ⅱ级,年龄42～64岁,体重51～81 kg,随机分为2组,顺式阿曲库铵0.075ms/ks组(Ⅰ组,n=11)和顺式阿曲库铵0.15 mg/kg组(Ⅱ组,n=14).静脉注射咪达唑仑0.035～0.045mg/kg、异丙酚1.5～2 mg/kg、芬太尼0.1～0.2 mg、顺式阿曲库铵0.075 mg/kg或0.15 mg/kg行麻醉诱导,吸入50%氧化亚氮、间断静脉注射芬太尼维持麻醉.采用2台TOF-Watch SX加速度肌松监测仪同步监测眼轮匝肌和拇内收肌的神经肌肉阻滞情况,记录肌松起效时间、无反应期及T25%和T75%恢复时间.于眼轮匝肌肌颤搐抑制75%～80%时行气管插管,并评价气管插管条件.结果 2组气管插管条件良好且差异无统计学意义(P>0.05);与Ⅰ组比较,Ⅱ组拇内收肌和眼轮匝肌肌松起效时间缩短,T25%恢复时间、T75%恢复时间和无反应期延长(P<0.01);与拇内收肌比较,Ⅰ组眼轮匝肌T75%恢复时间缩短,Ⅱ组眼轮匝肌无反应期和T25%恢复时间缩短(P<0.05或0.01).结论 顺式阿曲库铵对拇内收肌和眼轮匝肌的肌松效应呈剂量依赖性,眼轮匝肌对顺式阿曲库铵的敏感性低于拇内收肌;监测顺式阿曲库铵对眼轮匝肌神经肌肉阻滞情况可有效指导气管插管.
目的 比較不同劑量順式阿麯庫銨對患者拇內收肌與眼輪匝肌的肌鬆效應.方法 全痳患者25例,ASA Ⅰ或Ⅱ級,年齡42～64歲,體重51～81 kg,隨機分為2組,順式阿麯庫銨0.075ms/ks組(Ⅰ組,n=11)和順式阿麯庫銨0.15 mg/kg組(Ⅱ組,n=14).靜脈註射咪達唑崙0.035～0.045mg/kg、異丙酚1.5～2 mg/kg、芬太尼0.1～0.2 mg、順式阿麯庫銨0.075 mg/kg或0.15 mg/kg行痳醉誘導,吸入50%氧化亞氮、間斷靜脈註射芬太尼維持痳醉.採用2檯TOF-Watch SX加速度肌鬆鑑測儀同步鑑測眼輪匝肌和拇內收肌的神經肌肉阻滯情況,記錄肌鬆起效時間、無反應期及T25%和T75%恢複時間.于眼輪匝肌肌顫搐抑製75%～80%時行氣管插管,併評價氣管插管條件.結果 2組氣管插管條件良好且差異無統計學意義(P>0.05);與Ⅰ組比較,Ⅱ組拇內收肌和眼輪匝肌肌鬆起效時間縮短,T25%恢複時間、T75%恢複時間和無反應期延長(P<0.01);與拇內收肌比較,Ⅰ組眼輪匝肌T75%恢複時間縮短,Ⅱ組眼輪匝肌無反應期和T25%恢複時間縮短(P<0.05或0.01).結論 順式阿麯庫銨對拇內收肌和眼輪匝肌的肌鬆效應呈劑量依賴性,眼輪匝肌對順式阿麯庫銨的敏感性低于拇內收肌;鑑測順式阿麯庫銨對眼輪匝肌神經肌肉阻滯情況可有效指導氣管插管.
목적 비교불동제량순식아곡고안대환자무내수기여안륜잡기적기송효응.방법 전마환자25례,ASA Ⅰ혹Ⅱ급,년령42～64세,체중51～81 kg,수궤분위2조,순식아곡고안0.075ms/ks조(Ⅰ조,n=11)화순식아곡고안0.15 mg/kg조(Ⅱ조,n=14).정맥주사미체서륜0.035～0.045mg/kg、이병분1.5～2 mg/kg、분태니0.1～0.2 mg、순식아곡고안0.075 mg/kg혹0.15 mg/kg행마취유도,흡입50%양화아담、간단정맥주사분태니유지마취.채용2태TOF-Watch SX가속도기송감측의동보감측안륜잡기화무내수기적신경기육조체정황,기록기송기효시간、무반응기급T25%화T75%회복시간.우안륜잡기기전휵억제75%～80%시행기관삽관,병평개기관삽관조건.결과 2조기관삽관조건량호차차이무통계학의의(P>0.05);여Ⅰ조비교,Ⅱ조무내수기화안륜잡기기송기효시간축단,T25%회복시간、T75%회복시간화무반응기연장(P<0.01);여무내수기비교,Ⅰ조안륜잡기T75%회복시간축단,Ⅱ조안륜잡기무반응기화T25%회복시간축단(P<0.05혹0.01).결론 순식아곡고안대무내수기화안륜잡기적기송효응정제량의뢰성,안륜잡기대순식아곡고안적민감성저우무내수기;감측순식아곡고안대안륜잡기신경기육조체정황가유효지도기관삽관.
Objective To compare the neuromuscular blocking effects of different doses of cisatracuronium on orbicularis oculi and adductor pellicis muscle. Methods Twenty-five ASA Ⅰ or Ⅱ patients aged 42-64 yr weighing 51-81 kg undergoing elective operation under general anesthesia were randomly divided into 2 groups: group Ⅰ cisatracuronium 0.075 mg/kg (n = 11 ),group Ⅱ cisatracuronium 0.15 mg/kg (n = 14). Anesthesia was induced with iv midazolam 0.035-0.045 mg/kg, propofol 1.5-2 mg/kg, fentanyl 0.1-0.2 mg and cisatracuronium 0.075 mg/kg or 0.15 mg/kg and maintained with inhalation of 50% N20 and intermittent iv fentanyl. The neuromuscular blockade of orbicularis oculi and adductor poUicis muscle was determined simultaneously by acceleromyography. The onset time ( time from injection of cisatracuronium to maximal paralysis of twitch), period of no-twitch response and the 25% and 75% recovery time of the control height of twitch (T25%, T75% ) were recorded. Tracheal intubation was performed when the twitch of orbicularis oculi muscle was depressed by 75%-80% and then evaluated.Results The intubation conditions were good without significant difference between both groups( P 0.05). The onset time of orbicularis oculi and adductor pollicis muscle was significantly shorter and T25%, T75% and period of no-twitch response longer in group Ⅱ than in group Ⅰ (P < 0.01 ). The T25% and T75% of orbicularis oculi muscle in group Ⅰ and the period of no-twitch response and T25 % of orbicularis oculi muscle in group Ⅱ were shorter than those of adductor pollicis muscle ( P < 0.05 or 0.01 ). Conclusion Cisatracuronium can induce neuromuscular blockade at orbicularis oculi and adductor pollicis muscle in a dose-dependent manner and the sensitivity of orbicularis oculi muscle to cisatracuronium is lower than that of adductor pollicis muscle. The monitoring of cisatracuronium-induced neuromuscular blockade at orbicularis oculi muscle can effectively guide tracheal intubatiun.
