右美托咪定对顺式阿曲库铵肌松效应的影响
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摘要
目的探讨不同剂量右美托咪定对顺式阿曲库铵用量及肌松效应的影响。方法选择ASAⅠ～Ⅱ级,全身麻醉下行经鼻蝶窦垂体瘤切除术患者30例。应用字母表法随机分为3组,即右美托咪定Ⅰ组(DⅠ组)、右美托咪定Ⅱ组(DⅡ组)及生理盐水组(N组),每组10例。DⅠ组和DⅡ组均给予右美托咪定负荷量0. 5μg/kg,时间15min,继以0. 17μg/(kg·h)和0. 33μg/(kg·h)持续输注; N组在相同时间内给予等量生理盐水。术中3组均血浆靶控输注(TCI)丙泊酚并持续输注顺式阿曲库铵和舒芬太尼,根据脑电双频谱指数(BIS)值调节丙泊酚的靶浓度,根据肌松监测仪TOF值调节顺式阿曲库铵的输注速度。记录3组患者顺式阿曲库铵平均用量及起效时间、TOF比值(TOFR)恢复至25%、75%、90%的时间、恢复指数及不良反应。记录入室时、负荷剂量输注后及拔管期间收缩压(SBP)、舒张压(DBP)和心率(HR)。结果 3组中顺式阿曲库铵平均用量、起效时间、TOFR恢复至25%、75%、90%的时间、恢复指数比较,差异无统计学意义(P> 0. 05)。拔管期间SBP、DBP和HR与入室时比较,DⅠ组和DⅡ组无明显变化,N组HR显著升高(P <0. 05)。DⅠ组拔管期间HR和DⅡ组拔管期间HR、SBP、DBP均明显低于N组(P <0. 05)。结论右美托咪定对顺式阿曲库铵用量及肌松效应无影响,但右美托咪定可以有效抑制拔管等操作所诱发的应激反应,降低心肌耗氧量。
Objective To study the effects of different doses of dexmedetomidine given cisatracurium dosage and muscle-relaxation effects in total intravenous anesthesia( TIVA). Methods The 30 adult patients( ASAⅠorⅡ) scheduled for undergoing nasal transsphenoidal pituitary tumor resection under general anesthesia were randomly allocated to one of three groups: Group N,Group DⅠand Group DⅡ,each group of 10 cases. Group DⅠand Group DⅡ were given load dose of dexmedetomidine of 0. 5μg/kg in 15 min and following0. 17μg/( kg·h) or 0. 33μg/( kg·h) continuous infusion. Group N at the same time was given the same volume of saline. The three groups of patients were given with continuous infusion of sufentanil and cis-atracurium,TCI propofol. The propofol target plasma concentration was adjusted according to BIS. The cis-atracurium infusion speed was adjusted according to the TOF value. Recorded cis-atracurium average dose and onset time,train-of-four ratio( TOFR) recovered to 25%,75%,90% of the time and recovery index. Systolic blood pressure( SBP),diastolic blood pressure( DBP) and heart rate( HR) during baseline,after the loading dose infusion,extubation were recorded. Results The average dosage of cis-atracurium average dose,the onset time,time of TOFR recovered to 25%,75%,90% recovery index were not statistically significant between the three groups( P > 0. 05). During extubation,compared with the baseline,SBP,DBP and HR in Group DⅠand Group DⅡ had no obvious change,HR in Group N significantly increased( P < 0. 05). HR in Group DⅠand HR,SBP,DBP in GroupⅡ during extubation were significantly lower than those in group N( P < 0. 05). Conclusion In TIVA,dexmedetomidine had no effect on cis-atracurium dosage and muscle relaxant effect in department of neurosurgery operation.Dexmedetomidine can effectively inhibition of extubation stress response,reducing myocardial oxygen consumption.
Objective To study the effects of different doses of dexmedetomidine given cisatracurium dosage and muscle-relaxation effects in total intravenous anesthesia( TIVA). Methods The 30 adult patients( ASAⅠorⅡ) scheduled for undergoing nasal transsphenoidal pituitary tumor resection under general anesthesia were randomly allocated to one of three groups: Group N,Group DⅠand Group DⅡ,each group of 10 cases. Group DⅠand Group DⅡ were given load dose of dexmedetomidine of 0. 5μg/kg in 15 min and following0. 17μg/( kg·h) or 0. 33μg/( kg·h) continuous infusion. Group N at the same time was given the same volume of saline. The three groups of patients were given with continuous infusion of sufentanil and cis-atracurium,TCI propofol. The propofol target plasma concentration was adjusted according to BIS. The cis-atracurium infusion speed was adjusted according to the TOF value. Recorded cis-atracurium average dose and onset time,train-of-four ratio( TOFR) recovered to 25%,75%,90% of the time and recovery index. Systolic blood pressure( SBP),diastolic blood pressure( DBP) and heart rate( HR) during baseline,after the loading dose infusion,extubation were recorded. Results The average dosage of cis-atracurium average dose,the onset time,time of TOFR recovered to 25%,75%,90% recovery index were not statistically significant between the three groups( P > 0. 05). During extubation,compared with the baseline,SBP,DBP and HR in Group DⅠand Group DⅡ had no obvious change,HR in Group N significantly increased( P < 0. 05). HR in Group DⅠand HR,SBP,DBP in GroupⅡ during extubation were significantly lower than those in group N( P < 0. 05). Conclusion In TIVA,dexmedetomidine had no effect on cis-atracurium dosage and muscle relaxant effect in department of neurosurgery operation.Dexmedetomidine can effectively inhibition of extubation stress response,reducing myocardial oxygen consumption.
引文
1 Mohamed HS,Asida SM,Salman OH. Dexmedetomidine versus nimodipine for-controlled hypotension during spine surgery[J]. Egypt J Anaesth,2013,29(4):325-331
2 吴新民,王天龙,薛张纲,等.右美托咪定临床应用指导意见(2013)[J].中华麻醉学杂志,2013,33(10):1165-1167
3 Talke PO,Caldwell JE,Richardson CA,et al. The effects of dexmedetomidine on neuromuscular blockade in human volunteers[J].Anesth Analg,1999,88(3):633-639
4 Ozcan A,Ozcan N,Gulec H,et al. Comparison of the effects of fentanyl,remifentanil,and dexmedetomidine on neuromuscular blockade[J]. J Anesth,2013,26(2):196
5 Weinger MB,Partridge BL,Henry AF. Dexmedetomidine does not modify the neuromusular blocking action of vecuronium in the anaesthetized rat[J]. Br J Anaesth,1995,74(4):455-457
6 Zhang X,Bai X. New therapeutic uses for an alpha2 adrenergic receptor agonist-dexmedetomidine in pain management[J]. Neurosci Lett,2014,561(9):7-12
7 任志强,钱燕宁.麻黄碱对非去极化肌松药起效时间的影响[J].国际麻醉学与复苏杂志,2014,35(8):732-734
8 Lawrence CJ,Prinzen FW,de Lange S. The effect of dexmedetomidine on nutrient organ blood flow[J]. Anesth Analg,1996,83(6):1160-1165
9 赵艾华,冯立.顺式阿曲库铵的临床药理学研究进展[J].河北医药,2015,37(2):253-256
10 Ali MZ,Ebied RS,Atallah MA,et al. Cisatracurium dose-response relationship in patients with chronic liver disease[J]. Egypt J Anaesth,2014,30(2):197-202
11 Narimatsu E,Niiya T,Kawamata M,et al. Lack in effects of therapeutic concentrations of dexmedetomidine and clonidine on the neuromuscular blocking action of rocuronium in isolated rat diaphragms[J].Anesth Analg,2007,104(5):1116-1120
12 Sen S,Chakraborty J,Santra S,et al. The effect of dexmedetomidine infusion on propofol requirement for maintenance of optimum depth of anesthesia during elective spine surgery[J]. Indian J Anaesth,2013,57:358-363
13 梁晓君,张洪杰.不同剂量的右美托咪啶在老年颌面外科麻醉气管插管时对心血管反应的疗效比较[J].现代口腔医学杂志,2016,3:160-162
2 吴新民,王天龙,薛张纲,等.右美托咪定临床应用指导意见(2013)[J].中华麻醉学杂志,2013,33(10):1165-1167
3 Talke PO,Caldwell JE,Richardson CA,et al. The effects of dexmedetomidine on neuromuscular blockade in human volunteers[J].Anesth Analg,1999,88(3):633-639
4 Ozcan A,Ozcan N,Gulec H,et al. Comparison of the effects of fentanyl,remifentanil,and dexmedetomidine on neuromuscular blockade[J]. J Anesth,2013,26(2):196
5 Weinger MB,Partridge BL,Henry AF. Dexmedetomidine does not modify the neuromusular blocking action of vecuronium in the anaesthetized rat[J]. Br J Anaesth,1995,74(4):455-457
6 Zhang X,Bai X. New therapeutic uses for an alpha2 adrenergic receptor agonist-dexmedetomidine in pain management[J]. Neurosci Lett,2014,561(9):7-12
7 任志强,钱燕宁.麻黄碱对非去极化肌松药起效时间的影响[J].国际麻醉学与复苏杂志,2014,35(8):732-734
8 Lawrence CJ,Prinzen FW,de Lange S. The effect of dexmedetomidine on nutrient organ blood flow[J]. Anesth Analg,1996,83(6):1160-1165
9 赵艾华,冯立.顺式阿曲库铵的临床药理学研究进展[J].河北医药,2015,37(2):253-256
10 Ali MZ,Ebied RS,Atallah MA,et al. Cisatracurium dose-response relationship in patients with chronic liver disease[J]. Egypt J Anaesth,2014,30(2):197-202
11 Narimatsu E,Niiya T,Kawamata M,et al. Lack in effects of therapeutic concentrations of dexmedetomidine and clonidine on the neuromuscular blocking action of rocuronium in isolated rat diaphragms[J].Anesth Analg,2007,104(5):1116-1120
12 Sen S,Chakraborty J,Santra S,et al. The effect of dexmedetomidine infusion on propofol requirement for maintenance of optimum depth of anesthesia during elective spine surgery[J]. Indian J Anaesth,2013,57:358-363
13 梁晓君,张洪杰.不同剂量的右美托咪啶在老年颌面外科麻醉气管插管时对心血管反应的疗效比较[J].现代口腔医学杂志,2016,3:160-162