CAJ | 학술논문

目的顺式阿曲库铵是一种新型中效非去极化肌松药,具有不释放组胺,血流动力学稳定,经霍夫曼消除(非器官依赖代谢),不具累积效应等优点,但唯独起效时间较慢,本课题旨在研究在全麻诱导期间采用预注小剂量顺式阿曲库铵的方法缩短顺式阿曲库铵起效时间.方法选择全麻下行耳科手术的住院患者30例,随机分成2组,对照组(S组),小剂量顺式阿曲库铵预注组(C组),麻醉诱导用药:S组依次静注咪唑安定0.03 mg/kg,0.9%氯化钠注射液(3毫升),舒芬太尼0.5ug/kg,异丙酚1.5mg/kg;C组依次静注咪唑安定0.03 mg/kg,顺式阿曲库铵0.015mg/kg(3毫升),舒芬太尼0.5ug/kg,异丙酚1.5mg/kg.当患者意识消失,预注时间间隔为3分钟,S组静注顺式阿曲库铵0.15 mg/kg,C组静注顺式阿曲库铵0.135mg/kg,分别观察记录从静注肌松药后到T1抑制10%、25%、50%和100%时间(即肌松药起效时间),比较两组诱导前后、气管插管前、气管插管后1分钟、3分钟和5分钟各时点心率(HR)、平均动脉压(MAP)等指标变化.数据以均数加减标准差(x-±s)表示,计量资料组间采用独立样本T检验,计数资料采用χ2检验,P<0.05有统计学意义.结果两组患者诱导前后、气管插管前、气管插管后1分钟、3分钟及5分钟两组HR、MAP相比无统计学差异(P>0.05).两组比较顺式阿曲库铵肌松药起效时间的各时点都有统计学差异(p<0.01),分别为T1抑制10%(66±17.4)秒和(91.7±23.8)秒;T1抑制25%(108.9±34.0)秒和(167.7±35.1)秒;T1抑制50%(143.5±33.8)秒和(207.4±45.9)秒;T1抑制100%(178.9±42.7)秒和(245.3±54.5)秒.结论麻醉诱导期间预注小剂量顺式阿曲库铵(0.015mg/kg)比较单独静注相同剂量顺式阿曲库铵明显缩短了顺式阿曲库铵肌松药起效时间.
목적순식아곡고안시일충신형중효비거겁화기송약,구유불석방조알,혈류동역학은정,경곽부만소제(비기관의뢰대사),불구루적효응등우점,단유독기효시간교만,본과제지재연구재전마유도기간채용예주소제량순식아곡고안적방법축단순식아곡고안기효시간.방법선택전마하행이과수술적주원환자30례,수궤분성2조,대조조(S조),소제량순식아곡고안예주조(C조),마취유도용약:S조의차정주미서안정0.03 mg/kg,0.9%록화납주사액(3호승),서분태니0.5ug/kg,이병분1.5mg/kg;C조의차정주미서안정0.03 mg/kg,순식아곡고안0.015mg/kg(3호승),서분태니0.5ug/kg,이병분1.5mg/kg.당환자의식소실,예주시간간격위3분종,S조정주순식아곡고안0.15 mg/kg,C조정주순식아곡고안0.135mg/kg,분별관찰기록종정주기송약후도T1억제10%、25%、50%화100%시간(즉기송약기효시간),비교량조유도전후、기관삽관전、기관삽관후1분종、3분종화5분종각시점심솔(HR)、평균동맥압(MAP)등지표변화.수거이균수가감표준차(x-±s)표시,계량자료조간채용독립양본T검험,계수자료채용χ2검험,P<0.05유통계학의의.결과량조환자유도전후、기관삽관전、기관삽관후1분종、3분종급5분종량조HR、MAP상비무통계학차이(P>0.05).량조비교순식아곡고안기송약기효시간적각시점도유통계학차이(p<0.01),분별위T1억제10%(66±17.4)초화(91.7±23.8)초;T1억제25%(108.9±34.0)초화(167.7±35.1)초;T1억제50%(143.5±33.8)초화(207.4±45.9)초;T1억제100%(178.9±42.7)초화(245.3±54.5)초.결론마취유도기간예주소제량순식아곡고안(0.015mg/kg)비교단독정주상동제량순식아곡고안명현축단료순식아곡고안기송약기효시간.
@@@@Cisatracurium is a new nondepolarizing neuromuscular blocking agent(NNBA)with an intermediate duration of action, cisatracurium does not trigger histamine release,blood dynamics stability,which undergoes Hofmann elimination do not have accumulation effect etc.Cisatracurium has been considered a wonderful drug but only has a relatively slow onset time,so this issue was performed to study a small dose of cisatrucium in order to shorten the onset time of muscle relacxation during general endotracheal anesthesia. MethodsThirty patients undergoing ear surgeries in general anesthesia were include in the study. Par-ticipating patients were randomly assigned to two groups:placebo group(group S ),a small dose of cisatrucium group(group C),15 patients in each group. General endotracheal anaesthesia:Group S was induced with midazolam 0.03mg/kg,0.9%saline, sufentanile 0.5ug/kg,propofol 1.5mg/kg. Group C was induced with midazolam 0.03mg/kg,cisatracurium 0.015mg/kg,sufen-tanile 0.5ug/kg,propofol 1.5mg/kg,and all drugs were injected in 120s. The neuromuscular block was assessed and cisatracu-rium was administered after loss of consciousness. After 3 mins,Group S was injected 0.15mg/kg cisatracurium,group C was injected 0.135mg/kg cisatracurium. The times from the end of the cisatracurium bolus to 10%,25%,50%and maximum block were recorded. The heart rather(HR),mean arterial pressure(MAP)were recorded in every period of time during anesthesia administration,such as preanesthesia,after induction,before endotracheal intubation and 1,3,5 min after intubating. The value are reported as mean±SD,using analysis of variance for Unpaired Student’s t-tests for measurement data.χ2-tests for categori-cal data. P<0.05 was considered to be statistically significant. Results There were no statistical differences in baseline HR and baseline MAP(P>0.05). There were no statistical differences in HR and MAP after indused and before endotracheal intubat-ing or at 1,3 ,5 min after tracheal intubation(P>0.05).There were statistical differences at each quantum onset time of the cisatracurium in each group(p<0.01),the times to 10%neuromuscular blockade was shorter after a small dose of cisatracu-rium(66±17.4 vs91.7±23.8)s;the times to 25%neuromuscular blockade was(108.9±34.0 vs 167.7±35.1)s;the times to 50%neuromuscular blockade was(143.5±33.8 vs 207.4±45.9)s;the times to 100%neuromuscular blockade was(178.9±42.7 vs 245.3±54.5)s. ConclusionWe describe an onset time faster when cisatracurium was given during induction of anaesthesia after a small dose of cisatracurium(0.015mg/kg)