预注小剂量阿曲库铵对罗库溴铵缩肢反应的影响
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摘要
目的观察小剂量阿曲库铵预注对罗库溴铵全麻诱导引起缩肢反应的影响。方法选择2014年12月至2018年6月在钦州市第二人民医院择期气管插管全身麻醉下行外科手术治疗的女性患者100例,采用随机数表法将患者分为对照组(A组)和预注组(B组),每组50例。全麻诱导方法:A组依次静脉注射咪达唑仑0.05 mg/kg、舒芬太尼0.5μg/kg、依托咪酯0.3 mg/kg;B组依次注射阿曲库铵0.05 mg/kg、咪达唑仑0.05 mg/kg、舒芬太尼0.5μg/kg、依托咪酯0.3 mg/kg。待睫毛反射消失后,所有患者以0.5 mL/s的速度静脉注射罗库溴铵0.8 mg/kg,90～120 s后气管插管。记录诱导前(T0)、给药后气管插管前(T1)、插管即刻(T2)、插管后3 min (T3)、插管后5 min (T4)的平均动脉压(MAP)、心率(HR)的变化,观察罗库溴铵静脉注射时缩肢反应发生情况及麻醉诱导过程中兴奋焦虑、低氧饱和度、呛咳、肌肉僵直、误吸等其他不良反应发生情况。结果 A组患者注射罗库溴铵的缩肢反应发生率为22.0%,明显高于B组的6.0%,差异有统计学意义(P<0.05);A组患者推注舒芬太尼过程中呛咳反应发生率为38.0%,明显高于B组的12.0%,差异有统计学意义(P<0.05);两组患者麻醉诱导期间MAP、HR变化趋势大体一致,B组HR在T1、T3时点明显低于A组[T1:(75.8±13.2)次/min vs (81.5±15.2)次/min,T3:(75.5±13.2)次/min vs (82.7±17.2)次/min],差异均有统计学意义(P<0.05)。诱导期间无低氧饱和度、肌肉僵直等其它副反应。结论全麻诱导时预先静脉注射小剂量阿曲库铵可有效降低罗库溴铵缩肢反应的发生率,并减少舒芬太尼诱发的呛咳反应。
Objective To investigate the effect of pre-injecting small dose of atracurium on rocuronium-induced withdrawal movements. Methods From December 2014 to June 2018, 100 female patients undergoing general anesthesia for surgery in Second People's Hospital of Qinzhou City were randomly divided into two groups(n=50 in each group): control group(group A) and pretreatment group(group B). Group A received successively intravenous infusion of midazolam 0.05 mg/kg, sufentanyl 0.5 μg/kg, etomidate 0.3 mg/kg, while group B received successively atracurium 0.05 mg/kg, midazolam 0.05 mg/kg, sufentanyl 0.5 μg/kg, etomidate 0.3 mg/kg. When eyelash reflex was abolished,the rocuronium 0.8 mg/kg was injected(at an injection rate of 0.5 mL/s). After 90 to 120 seconds, all patients were intubated. The heart rate(HR) and mean arterial pressure(MAP) at the time of before anesthesia induction(T0), after administration and before intubation(T1), intubating(T2), 3 minutes after intubation(T3), 5 minutes after intubation(T4) were recorded. The incidence of withdrawl movements, cough, and other side-effects during anesthesia induction were observed. Results The incidence of withdrawal response was 22.0% in group A and 6.0% in group B(P<0.05). The incidence of sufentanyl-induced cough was 38.0% in group A and 12.0% in group B(P<0.05). Compared with group A, the incidences of rocuronium-induced withdrawal movements and sufentanyl-induced cough were decreased significantly in group B(P<0.05). MAP and HR showed no significant differences during anesthesia induction between two groups of patients. The heart rate at the time of T1, T3 in group B were lower than those in group A(P<0.05): T1,(75.8±13.2) beats/min vs(81.5±15.2) beats/min; T3,(75.5±13.2) beats/min vs(82.7±17.2) beats/min. Conclusion Pre-injecting small dose of atracurium can effectively reduce rocuronium-induced withdrawal movements and sufentanyl-induced cough response during anesthetic induction.
Objective To investigate the effect of pre-injecting small dose of atracurium on rocuronium-induced withdrawal movements. Methods From December 2014 to June 2018, 100 female patients undergoing general anesthesia for surgery in Second People's Hospital of Qinzhou City were randomly divided into two groups(n=50 in each group): control group(group A) and pretreatment group(group B). Group A received successively intravenous infusion of midazolam 0.05 mg/kg, sufentanyl 0.5 μg/kg, etomidate 0.3 mg/kg, while group B received successively atracurium 0.05 mg/kg, midazolam 0.05 mg/kg, sufentanyl 0.5 μg/kg, etomidate 0.3 mg/kg. When eyelash reflex was abolished,the rocuronium 0.8 mg/kg was injected(at an injection rate of 0.5 mL/s). After 90 to 120 seconds, all patients were intubated. The heart rate(HR) and mean arterial pressure(MAP) at the time of before anesthesia induction(T0), after administration and before intubation(T1), intubating(T2), 3 minutes after intubation(T3), 5 minutes after intubation(T4) were recorded. The incidence of withdrawl movements, cough, and other side-effects during anesthesia induction were observed. Results The incidence of withdrawal response was 22.0% in group A and 6.0% in group B(P<0.05). The incidence of sufentanyl-induced cough was 38.0% in group A and 12.0% in group B(P<0.05). Compared with group A, the incidences of rocuronium-induced withdrawal movements and sufentanyl-induced cough were decreased significantly in group B(P<0.05). MAP and HR showed no significant differences during anesthesia induction between two groups of patients. The heart rate at the time of T1, T3 in group B were lower than those in group A(P<0.05): T1,(75.8±13.2) beats/min vs(81.5±15.2) beats/min; T3,(75.5±13.2) beats/min vs(82.7±17.2) beats/min. Conclusion Pre-injecting small dose of atracurium can effectively reduce rocuronium-induced withdrawal movements and sufentanyl-induced cough response during anesthetic induction.
引文
[1] PARK SH, OH AY, GOO EK, et al. A short period of inhalation induction with sevoflurane prevents rocuronium-induced withdrawal in children[J]. Acta Anaesthesiol Scand, 2011, 55(1):87-91.
[2] XIAOXIA AN, CAIXIA LI, ZAYD SAHEBALLY, et al. Pretreatment with oxycodone simultaneously reduces etomidate-induced myoclonus and rocuronium-induced withdrawal movements during rapid sequence induction[J]. Med Sci Monit, 2017, 23:4989-4994.
[3] MAHAJAN C, RATH GP, BITHAL PK, et al. Local warming at injection site helps alleviate pain after rocuronium administration[J]. J Anesth, 2010, 24(6):845-848.
[4]马皓琳,庄心良,孔宁,等.罗库溴铵和阿曲库铵的预注量对相互起效的影响[J].临床麻醉学杂志,2001, 17(10):535-537.
[5] AHMAD N, CHOY CY, ARIS EA, et al. Preventing the withdrawal response associated with rocuronium injection:a comparison of fentanyl with lidocaine[J]. Anesth Analg, 2005, 100(4):987-990.
[6] EYIGOR C, CEYLAN A, DEMIR F, et al. Superficial venous thrombophlebitis caused by rocuronium[J]. J Anesth, 2010, 24(4):646-648.
[7] KIM YH, GO YK, LEE JU, et al. Pretreatment with nafamostat mesilate, a kallikrein inhibitor, to decrease withdrawal response associated with rocuronium[J]. J Anesth, 2010, 24(4):549-552.
[8] PARK SJ, PARK HJ, CHOI JY, et al. The influence of age and gender on remifentanil EC(50)for preventing rocuronium induced withdrawal movements[J]. Korean J Anesthesiol, 2010, 58(3):244-248.
[9] KIM KS, KIM YS, JOEN WJ, et al. Prevention of with drawal associated with the injection of rocuronium in adults and children[J]. J Clin Anesth, 2006, 18(5):334-338.
[10] GEUN JOO CHOI, SANGSEOK LEE, JEOUNG HYUK LEE, et a1.Pharmacological and non-pharmacological intervention for rocuronium-induced withdrawal movement in the Korean population:a meta-analysis of 41 studies including 4,742 subjects[J]. Korean J Anesthesiol, 2014, 66(6):419-432.
[11] YEOM JH, KIM KH, CHOE GH, et a1. End-tidal concentration of sevoflurane for reducing rocuronium-induced with drawal reactions in adult patients:a comparison between male and female patients[J]. Korean J Anesthesiol, 2014, 66(6):439-443.
[12] ABU-HALAWEH SA, ALOWEIDI AK, QUDAISAT IY, et a1. Comparison of three methods of preventing rocuronium induced pain on injection using venous occlusion technique:a randomized prospective double blind controlled study[J]. Middle East J Anaesthesiol,2013, 22(1):87-92.
[13] KWAK HJ, KIM JY, KIM YB, et a1. Pharmacological prevention of rocuronium-induced injection pain or withdrawal movements:a meta-analysis[J]. J Anesth, 2013, 27(5):742-749.
[14] SINGH M, CHAUHAN H, RATH GP, et a1. Effect of narcotic pretreatment on pain after rocuronium injection:a randomized, double-blind controlled comparison with lidocaine[J]. J Anesth, 2007,21(4):510-512.
[15]陈玲阳,林仙菊,吴美燕,等.舒芬太尼预防罗库溴铵诱发肢体退缩反应合适给药时间观察[J].医药导报, 2014, 33(9):1182-1184.
[16]曾婉华,欧阳葆怡.利多卡因、曲马多和枢复宁对预防罗库溴铵注射痛的对比研究[J].海南医学,2005, 16(8):30-32.
[17]胡四平,汪卫星,吴鹤芬.罗库溴铵伍用阿曲库铵全麻有道的效果评价[J].浙江医学, 2007, 69(5):510-511.
[2] XIAOXIA AN, CAIXIA LI, ZAYD SAHEBALLY, et al. Pretreatment with oxycodone simultaneously reduces etomidate-induced myoclonus and rocuronium-induced withdrawal movements during rapid sequence induction[J]. Med Sci Monit, 2017, 23:4989-4994.
[3] MAHAJAN C, RATH GP, BITHAL PK, et al. Local warming at injection site helps alleviate pain after rocuronium administration[J]. J Anesth, 2010, 24(6):845-848.
[4]马皓琳,庄心良,孔宁,等.罗库溴铵和阿曲库铵的预注量对相互起效的影响[J].临床麻醉学杂志,2001, 17(10):535-537.
[5] AHMAD N, CHOY CY, ARIS EA, et al. Preventing the withdrawal response associated with rocuronium injection:a comparison of fentanyl with lidocaine[J]. Anesth Analg, 2005, 100(4):987-990.
[6] EYIGOR C, CEYLAN A, DEMIR F, et al. Superficial venous thrombophlebitis caused by rocuronium[J]. J Anesth, 2010, 24(4):646-648.
[7] KIM YH, GO YK, LEE JU, et al. Pretreatment with nafamostat mesilate, a kallikrein inhibitor, to decrease withdrawal response associated with rocuronium[J]. J Anesth, 2010, 24(4):549-552.
[8] PARK SJ, PARK HJ, CHOI JY, et al. The influence of age and gender on remifentanil EC(50)for preventing rocuronium induced withdrawal movements[J]. Korean J Anesthesiol, 2010, 58(3):244-248.
[9] KIM KS, KIM YS, JOEN WJ, et al. Prevention of with drawal associated with the injection of rocuronium in adults and children[J]. J Clin Anesth, 2006, 18(5):334-338.
[10] GEUN JOO CHOI, SANGSEOK LEE, JEOUNG HYUK LEE, et a1.Pharmacological and non-pharmacological intervention for rocuronium-induced withdrawal movement in the Korean population:a meta-analysis of 41 studies including 4,742 subjects[J]. Korean J Anesthesiol, 2014, 66(6):419-432.
[11] YEOM JH, KIM KH, CHOE GH, et a1. End-tidal concentration of sevoflurane for reducing rocuronium-induced with drawal reactions in adult patients:a comparison between male and female patients[J]. Korean J Anesthesiol, 2014, 66(6):439-443.
[12] ABU-HALAWEH SA, ALOWEIDI AK, QUDAISAT IY, et a1. Comparison of three methods of preventing rocuronium induced pain on injection using venous occlusion technique:a randomized prospective double blind controlled study[J]. Middle East J Anaesthesiol,2013, 22(1):87-92.
[13] KWAK HJ, KIM JY, KIM YB, et a1. Pharmacological prevention of rocuronium-induced injection pain or withdrawal movements:a meta-analysis[J]. J Anesth, 2013, 27(5):742-749.
[14] SINGH M, CHAUHAN H, RATH GP, et a1. Effect of narcotic pretreatment on pain after rocuronium injection:a randomized, double-blind controlled comparison with lidocaine[J]. J Anesth, 2007,21(4):510-512.
[15]陈玲阳,林仙菊,吴美燕,等.舒芬太尼预防罗库溴铵诱发肢体退缩反应合适给药时间观察[J].医药导报, 2014, 33(9):1182-1184.
[16]曾婉华,欧阳葆怡.利多卡因、曲马多和枢复宁对预防罗库溴铵注射痛的对比研究[J].海南医学,2005, 16(8):30-32.
[17]胡四平,汪卫星,吴鹤芬.罗库溴铵伍用阿曲库铵全麻有道的效果评价[J].浙江医学, 2007, 69(5):510-511.