七氟醚对阿曲库铵肌松作用的影响
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摘要
目的:探讨七氟醚对阿曲库铵的药效作用强度,临床作用时间以及肌松恢复的影响。
方法:45例择期腹部肿瘤手术全麻患者,ASA分级Ⅰ-Ⅱ级,年龄40-60岁,无神经肌肉系统疾病病史,肝肾功能正常,术前未用已知的可影响神经肌肉传导功能的药物。将病人随机分为三组:P组:异丙酚+阿曲库铵肌松维持组;I组:异氟醚+阿曲库铵肌松维持组;S组:七氟醚+阿曲库铵肌松维持组。术前30分钟肌肉注射0.5mg阿托品。麻醉诱导前建立稳定的肌松监测,在TOF模式监测下,麻醉诱导:咪达唑仑0.04-0.05mg/kg,舒芬太尼0.5ug/kg,依托咪酯0.3mg/kg,病人入睡推注阿曲库铵0.6mg/kg(20秒注毕),待T_1降至5%以下时行气管内插管。麻醉维持:异丙酚持续血浆靶控输注1-4ug/ml,复合瑞芬太尼0.25ug/kg/min输注(P组n=15);异氟醚呼气末浓度维持在1.2MAC(I组n=15),术中必要时追加舒芬太尼0.3-0.5ug/kg;七氟醚呼气末浓度维持在1.2MAC(S组n=15),术中必要时追加舒芬太尼0.3-0.5ug/kg,阿曲库铵在三组均在阿曲库铵首次剂量注毕后,至T_1术值恢复到25%时,启动阿曲库铵恒速输注,剂量为0.5mk/kg/h。毕前20分钟左右停止输注阿曲库铵,此后任其自然恢复,不予任何拮抗药。术毕时停止异丙酚输注,异氟醚、七氟醚吸入,待病人完全恢复(即TOFR＞0.7,潮气量＞400ml,且能呼之睁眼并持续抬头5秒以上)即可常规吸痰拔除气管导管。三组在诱导过程及麻醉维持中,BIS值控制在45-55范围内,HR和MAP的值控制在HR(80-120次/min),MAP(60-90mmHg)范围内,P_(ET)CO_2维持在35-45mmHg。术中记录:T_1降至5%的时间及此时的气管插管条件:麻醉诱导时(T1)、气管插管前即刻(T2)、气管插管后即刻(T3)、气管插管后5min(T4)、T_1 25%(T5)、启动阿曲库铵恒速输注后5min(T6)、术前20分钟停止输注阿曲库铵(T7)、T_175%(T8)、TOFR0.7(T9)九个时间点的MAP、HR、SpO_2、P_(ET)CO_2、BIS值以及食道温度的变化。并记录起效时间(即阿曲库铵注毕至T_1降至0%的时间)、临床维持时间(T_125%.即阿曲库铵注毕至T_1恢复到25%的时间)、T_175%(即阿曲库铵注毕至T_1恢复到75%的时间)、恢复指数(T_1高度从25%到75%的时间)以及TOFR0.7的时间(T_4/T_1=0.7)。
结果:
1、麻醉诱导
麻醉诱导注入阿曲库铵0.6mg/kg后,当T_1＜5%时行气管插管,插管条件满意评分8.64±0.5(根据Krirg改良法评分);P组、I组和S组三组内T2-T8与T1比较血压降低(P＜0.05);三组内T2与T1比较心率降低(P＜0.05)。
2、阿曲库铵的起效
阿曲库铵的起效在P组、I组和S组比较无统计学意义(P＞0.05)。
3、阿曲库铵的维持时间
P组、I组和S组的首剂阿曲库铵从注射到T_1为25%,各组之间比较,均有统计学意义(均P＜0.05),在I组和S组肌松时间延长,S组肌松时间延长更长(P＜0.05)。
4、阿曲库铵的肌松恢复
P组、I组和S组各组的恢复指数之间比较,均有统计学意义(均P＜0.05),I组和S组时间延长,I组时间延长更长(P＜0.05);各组的TOFR0.7两两之间比较,均有统计学意义(均P＜0.05),在I组和S组时间延长,I组时间延长更长(P＜0.05)。
结论:
1、1.2 MAC七氟醚、异氟醚维持麻醉可延长阿曲库铵的肌松时间和肌松恢复时间。
2、七氟醚维持麻醉延长阿曲库铵的肌松时间较异氟醚长,且麻醉结束时肌松恢复时间较异氟醚短。
Purpose:To discuss the influnce of sevoflurane anesthesia to the randomized styudy,dose-response relationship and nuromuscular recover of atracurium.
Methods:Forty-five patients of abdominal surgery,ASA physical statusⅠorⅡ,cheduled to undergo elective surgical procedures were studied. Patients with hepatic,renal or neuromuscular diseases and those on med-Ications known to affect neuomuscular blocking drugs were excluded. Forty-five patients were randomly divided into three groups:Group P,propofol and atracurium;Group I,isoflurane and atracurium;Group S,sevoflurane and inatracurium.Patients were premedicated with injection atropine 0.01mg/kg intramuscularly30 minutes before surgery,anesthesia was induce with midazolam0.04-0.05mg/kg,sulfentanyl 0.5ug/kg,followed by etomidate 0.3mg/ kg and maintained with oxygen100%,Afert bolus dose of atracurium 0.6mg/kg,intubation was performed as soon as the fiest response to TOF stimulus T_1 fell below 5%.After tracheal intubation, propofol 1-4ug/ml and supplements of remifentanil 0.25 ug/kg/min(group P:n=15);end-tidal concentrations 1.2MAC isoflurane(group I:n=15) endtidal concentrations 1.2MAC sevoflurane(group S:n=15).The atracuriums infusion was discontinued approximately 20-min before termination of the operation.Let it recover in nature,do not give any reversal drug.When the surgery is over,the propofol's influsion and isoflurane,sev oflurane's inhalation was discontinued approximately.Spontaneous recovery of muscular function was then allowed to proceed.The criteria for full recovery form neuromuscular blochade were a measured tidal volume of greater than 400 ml,and the ability to sustain a head lift for 5s,and the TOF ratio geater than 70%.During nesthesia induction and maintenance,the range of BIS was form 45 to 55,MAP was form 60mmHg to90mmHg,HR was form 60 to 120 and P_(ET)CO_2 was form 35mmHg to 45mmHg.Record after blous does of atracurium 0.6mg/kg intubation was performed as soon as the first response to TOF stimulus T_1 fell below 5%.The variations of MAP,HR,SpO_2 and P_(ET)CO_2 were recorded at nine time points:anesthesia intubation(T1);the moment just before intubation(T2);the moment just after intu-bation(T3);five minutes after intubation(T4);T_1 recover to 25%(T5);Five minutes after to add the atracurium at first(T6);The time of the atracurium's infusion was discontinued approximately 20-min before termination of the operation (T7);T_1 recover to 75%(T8);TOFR 0.7(T9).The TOF mode of stimulation was used.The variables recorded were as follows:onset time(time form drug administration to maximum effects),time recovery of T_1 to 25%and 75%of control,recovery index(time form T_1 25%to 75%) and TOFR0.7(T_4/T_1).
Results:1.Tracheal intubation was achieved after injective of a bolus dose of atracurium 0.6mg/kg;In the three groups,the blood pressure at T2-T8 was lower than at T1(P＜0.05);the HR at T2 was less than at T1,T3-T9 (P＜0.05).2.The onset time of atracurium in the three groups,the onset was not different.(P＞0.05).3.The clinical duration of atracurium of the first dose was found to be longer in the groups and group I than in the group P(P＜0.05),and also in the group S was longer than in the group I(P＜0.05).4.The recovery of atracurium was longer in the groupS and group I than in the group P(P＜0.05);and also in the group I was longer than in the group S(P＜0.05);The TOFR0.7 was longer in the group I and group S than in the group P(P＜0.05),and also in the group I was longer than in the group S(P＜0.05).
Conclusions:1.Maintenance sevoflurane at 1.2MAC and isoflurane at 1.2 AC end-tital concentrations can prolong the clinical duration,and the recovery index.2.Maintenance sevoflurane oncentrations can prolong the clinical durationat is longer than isoflurane,and the recovery index is shorter than isoflurane when the anesthesia is over.
方法:45例择期腹部肿瘤手术全麻患者,ASA分级Ⅰ-Ⅱ级,年龄40-60岁,无神经肌肉系统疾病病史,肝肾功能正常,术前未用已知的可影响神经肌肉传导功能的药物。将病人随机分为三组:P组:异丙酚+阿曲库铵肌松维持组;I组:异氟醚+阿曲库铵肌松维持组;S组:七氟醚+阿曲库铵肌松维持组。术前30分钟肌肉注射0.5mg阿托品。麻醉诱导前建立稳定的肌松监测,在TOF模式监测下,麻醉诱导:咪达唑仑0.04-0.05mg/kg,舒芬太尼0.5ug/kg,依托咪酯0.3mg/kg,病人入睡推注阿曲库铵0.6mg/kg(20秒注毕),待T_1降至5%以下时行气管内插管。麻醉维持:异丙酚持续血浆靶控输注1-4ug/ml,复合瑞芬太尼0.25ug/kg/min输注(P组n=15);异氟醚呼气末浓度维持在1.2MAC(I组n=15),术中必要时追加舒芬太尼0.3-0.5ug/kg;七氟醚呼气末浓度维持在1.2MAC(S组n=15),术中必要时追加舒芬太尼0.3-0.5ug/kg,阿曲库铵在三组均在阿曲库铵首次剂量注毕后,至T_1术值恢复到25%时,启动阿曲库铵恒速输注,剂量为0.5mk/kg/h。毕前20分钟左右停止输注阿曲库铵,此后任其自然恢复,不予任何拮抗药。术毕时停止异丙酚输注,异氟醚、七氟醚吸入,待病人完全恢复(即TOFR＞0.7,潮气量＞400ml,且能呼之睁眼并持续抬头5秒以上)即可常规吸痰拔除气管导管。三组在诱导过程及麻醉维持中,BIS值控制在45-55范围内,HR和MAP的值控制在HR(80-120次/min),MAP(60-90mmHg)范围内,P_(ET)CO_2维持在35-45mmHg。术中记录:T_1降至5%的时间及此时的气管插管条件:麻醉诱导时(T1)、气管插管前即刻(T2)、气管插管后即刻(T3)、气管插管后5min(T4)、T_1 25%(T5)、启动阿曲库铵恒速输注后5min(T6)、术前20分钟停止输注阿曲库铵(T7)、T_175%(T8)、TOFR0.7(T9)九个时间点的MAP、HR、SpO_2、P_(ET)CO_2、BIS值以及食道温度的变化。并记录起效时间(即阿曲库铵注毕至T_1降至0%的时间)、临床维持时间(T_125%.即阿曲库铵注毕至T_1恢复到25%的时间)、T_175%(即阿曲库铵注毕至T_1恢复到75%的时间)、恢复指数(T_1高度从25%到75%的时间)以及TOFR0.7的时间(T_4/T_1=0.7)。
结果:
1、麻醉诱导
麻醉诱导注入阿曲库铵0.6mg/kg后,当T_1＜5%时行气管插管,插管条件满意评分8.64±0.5(根据Krirg改良法评分);P组、I组和S组三组内T2-T8与T1比较血压降低(P＜0.05);三组内T2与T1比较心率降低(P＜0.05)。
2、阿曲库铵的起效
阿曲库铵的起效在P组、I组和S组比较无统计学意义(P＞0.05)。
3、阿曲库铵的维持时间
P组、I组和S组的首剂阿曲库铵从注射到T_1为25%,各组之间比较,均有统计学意义(均P＜0.05),在I组和S组肌松时间延长,S组肌松时间延长更长(P＜0.05)。
4、阿曲库铵的肌松恢复
P组、I组和S组各组的恢复指数之间比较,均有统计学意义(均P＜0.05),I组和S组时间延长,I组时间延长更长(P＜0.05);各组的TOFR0.7两两之间比较,均有统计学意义(均P＜0.05),在I组和S组时间延长,I组时间延长更长(P＜0.05)。
结论:
1、1.2 MAC七氟醚、异氟醚维持麻醉可延长阿曲库铵的肌松时间和肌松恢复时间。
2、七氟醚维持麻醉延长阿曲库铵的肌松时间较异氟醚长,且麻醉结束时肌松恢复时间较异氟醚短。
Purpose:To discuss the influnce of sevoflurane anesthesia to the randomized styudy,dose-response relationship and nuromuscular recover of atracurium.
Methods:Forty-five patients of abdominal surgery,ASA physical statusⅠorⅡ,cheduled to undergo elective surgical procedures were studied. Patients with hepatic,renal or neuromuscular diseases and those on med-Ications known to affect neuomuscular blocking drugs were excluded. Forty-five patients were randomly divided into three groups:Group P,propofol and atracurium;Group I,isoflurane and atracurium;Group S,sevoflurane and inatracurium.Patients were premedicated with injection atropine 0.01mg/kg intramuscularly30 minutes before surgery,anesthesia was induce with midazolam0.04-0.05mg/kg,sulfentanyl 0.5ug/kg,followed by etomidate 0.3mg/ kg and maintained with oxygen100%,Afert bolus dose of atracurium 0.6mg/kg,intubation was performed as soon as the fiest response to TOF stimulus T_1 fell below 5%.After tracheal intubation, propofol 1-4ug/ml and supplements of remifentanil 0.25 ug/kg/min(group P:n=15);end-tidal concentrations 1.2MAC isoflurane(group I:n=15) endtidal concentrations 1.2MAC sevoflurane(group S:n=15).The atracuriums infusion was discontinued approximately 20-min before termination of the operation.Let it recover in nature,do not give any reversal drug.When the surgery is over,the propofol's influsion and isoflurane,sev oflurane's inhalation was discontinued approximately.Spontaneous recovery of muscular function was then allowed to proceed.The criteria for full recovery form neuromuscular blochade were a measured tidal volume of greater than 400 ml,and the ability to sustain a head lift for 5s,and the TOF ratio geater than 70%.During nesthesia induction and maintenance,the range of BIS was form 45 to 55,MAP was form 60mmHg to90mmHg,HR was form 60 to 120 and P_(ET)CO_2 was form 35mmHg to 45mmHg.Record after blous does of atracurium 0.6mg/kg intubation was performed as soon as the first response to TOF stimulus T_1 fell below 5%.The variations of MAP,HR,SpO_2 and P_(ET)CO_2 were recorded at nine time points:anesthesia intubation(T1);the moment just before intubation(T2);the moment just after intu-bation(T3);five minutes after intubation(T4);T_1 recover to 25%(T5);Five minutes after to add the atracurium at first(T6);The time of the atracurium's infusion was discontinued approximately 20-min before termination of the operation (T7);T_1 recover to 75%(T8);TOFR 0.7(T9).The TOF mode of stimulation was used.The variables recorded were as follows:onset time(time form drug administration to maximum effects),time recovery of T_1 to 25%and 75%of control,recovery index(time form T_1 25%to 75%) and TOFR0.7(T_4/T_1).
Results:1.Tracheal intubation was achieved after injective of a bolus dose of atracurium 0.6mg/kg;In the three groups,the blood pressure at T2-T8 was lower than at T1(P＜0.05);the HR at T2 was less than at T1,T3-T9 (P＜0.05).2.The onset time of atracurium in the three groups,the onset was not different.(P＞0.05).3.The clinical duration of atracurium of the first dose was found to be longer in the groups and group I than in the group P(P＜0.05),and also in the group S was longer than in the group I(P＜0.05).4.The recovery of atracurium was longer in the groupS and group I than in the group P(P＜0.05);and also in the group I was longer than in the group S(P＜0.05);The TOFR0.7 was longer in the group I and group S than in the group P(P＜0.05),and also in the group I was longer than in the group S(P＜0.05).
Conclusions:1.Maintenance sevoflurane at 1.2MAC and isoflurane at 1.2 AC end-tital concentrations can prolong the clinical duration,and the recovery index.2.Maintenance sevoflurane oncentrations can prolong the clinical durationat is longer than isoflurane,and the recovery index is shorter than isoflurane when the anesthesia is over.
引文
[1]李海波,李德惠,赵欢.等.琥珀胆碱对罗库溴铵作用的影响.临床麻醉学杂志,2000,16(7):337-339.
[2]雷利明,张文胜,刘进,等.七氟醚的临床研究及进展.四川解剖学杂志,2006,14(3):45-47.
[3]Campagna JA,Miller KW,Forman SA.Mechanisms of actions of inhaled anesthetics,N Engi J Med,2003,22;348(21):2110-2124.
[4]Wu XS,Sun JV,Evers AS,et al.Isoflurane inhibits transmitter release and the presynaptic action potential.Anesthesiology,2004,100(3):470-2.
[5]颜梅,戴体俊.吸入麻醉药镇痛、催眠作用与GABAA受体的关系.中国药理学通报,2004,20:521-523.
[6]Urban BW.Current assessment of targets and theories of anesthesia.Br J Anaesth,2002,89(1):167-83.
[7]李传翔,姚尚龙,聂辉,等.七氟醚对非去极化肌松药与肌肉乙酰胆碱受体作用的影响.中国药理学通报,2005,21-9:1081-4.
[8]Fodale V,Santamaria LB.Laudanosine,an atracurium and cisatracurium metabo- lite.Eur Anaesthesiol,2002,19(7):466-73.
[9]Ma H,Zhuang X.Selection of neuromuscular blocking agents in patients undergoing renal transplantation under general anesthesia.Chin Med J(Engl),2002:115(11):1692-6.
[10]Della Rocca G,Pompei L,Coccia C,et al.Atracuriu m,cisatra curium,vecuronium and rocuronium in patients with renal failure.Minerva Anestesiol,2003:69(7-8):605-11,612,5.
[11]邹伟,王瑞,高椿霖,等.全凭静脉麻醉下持续输注国产阿曲库铵的药效学观察.中国药房,2005,16(12):926-927.
[12]Lallemand MA,Lentschener C,Mazoit JX,et al.Bispectral index changes following etomidate induction of general anesthesia and orotracheal intubation.Br Anaesth,2003,91(3):341-6.
[13]张军,梁伟民,顾华华.等.不同浓度吸入麻醉药对脑电双频指数的影响.临床麻醉学杂志,2002,10,18(10):548-550.
[14]刘威,闻大翔,杭燕南,等.四种中时效非去极化肌松药组胺释放作用的研究.上海第二医科大学学报,2003,23(5):445-8.
[15]刘俊杰,赵俊.现代麻醉学[M],第2版,北京:人民卫生出版社,2000:318-319.
[16]刘利怡,廖旭,薛富善,等.舒芬太尼的药理学和临床应用[J].中国医药导刊,2005,7(6):454-457.
[17]唐红利,耿武军,董冬梅,等.舒芬太尼对鼻内镜手术围拔管期对血流动力学的影响.浙江医学,2007,29(3):262-263.
[18]于布为,薛庆生,罗艳,等.吸入麻醉药物的研究进展.继续医学教育,2007.20(15):26-36.
[19]刘琴湘,许春雷,邹冬玲,等.靶控输注丙泊酚复合硬膜外麻醉在腹腔镜下胆囊切除术中的应用[J].中国新药与临床杂志,2005,24(7):539-542.
[20]吴新民,叶铁虎,岳云,等.国产注射用瑞芬太尼有效性和安全性的评价.中华麻醉学杂志,2003,23(4):245.
[21]赵高峰,张兴安,吴群林,等.靶控输注异丙酚复合瑞芬太尼或芬太尼全静脉麻醉.广东医学,2004,25(7):765.
[22]Miller RD.Academic anesthesia faculty salaries:incentive s,availability,and productivity.Anesth Analg,2005,100(2):487-9.
[23]Paul M,Fokt RM,Kindler CH,et al.Characterizatoion of the interactions between volatile anesthetics and neuromuscular blockers at the muscle nicotinic acetylcholine receptor.Anesth Analg,2002,95(2):362-7.
[24]Dragne A,Varin F,Plaud B,et al,Rocuronium pharmacokinetic relationship under stable propofol or isoflurane anesthesia.Can J Anaesth,2002,49(4):353-60.
[25]Murphy GS,Szokol JW,Franklin M,et al.Postanesthesia careunit recovery times and neuromuscular blocking drugs:A prospective study of orthopedic surgical patients randomized to receive pancuronium or rocuronium.Anesth Analg,2004,98(1):193-200.
[26]杨在启,魏淑明.七氟醚或异氟醚对阿曲库铵血浆靶控.社区医学杂志,2006,4(9):28-29.
[27]McCaul C,Tobin E,Boylan JF,et al.Atracurium is associated with postoperative residual curarization.Br J Anaesth.2002,89(5):766-9.
[28]Fawcett WJ.Atracurium is associated with postoperative residual curarization.Br J Anaesth,2003,90(6):810.
[29]Hayes AH,Mirakhur RK,Breslin DS,et al.Postoperative residual block after intermediate-acting neuromuscular blocking drugs.Anaesthesia,2001,56(4):312-8.
[30]Kopman AF,Zank LM,Ng J,et al.Antagonism of cisatracurium and rocuronium block at a tactile train-of-four count of 2:should quantitative of assessment neuromuscular function be mandatory ?Anesth Analg,2004,98(1):102-6.
[31]Gatke MR,Viby-Mogensen J,Rosenstock C,et al.Postoperative muscle paralysis after rocuronium:less residual block when acceleromyography is used.Acta Anaesthe- siol Scand,2002,46(2):207-13.
[32]Cammu G,de Baerdemaeker L,den Blauwen N,et al.Postoperative residual curarization with cisatracurium and rocuronium infusions.Eur J Anaesthesiol,2002,19(2):129- 34.
[33]Jonsson M,Kim C,Yamamoto Y,et al.Atracurium and vecuronium block nicotine induced carotid body chemoreceptor responses.Acta Anaesthesiol Scand,2002,46(5):488-94.
[34]沈亮,严谨,陆志俊,等.新斯的明拮抗国产阿曲库铵效果及对Q、T 离散度的影响.临床麻醉学杂志,2004,20:387-389.
[1]李德惠,李海波,赵欢,等.琥珀胆碱对罗库溴铵作用的影响.临床麻醉学杂志,2000,16(7):337-339.
[2]庄心良,曾因明,陈伯銮,等.现代麻醉学.第三版.北京:人民卫生出版社,2004,745.
[3]杨保仲,庄心良,赵雪莲,等.肌肉型乙酰胆碱受体在HEK293细胞上的表达.中国药理学通报,2004,20(10):1186-9.
[4]李传翔,姚尚龙,聂辉,等.七氟醚对非去极化肌松药与肌肉乙酰胆碱受体作用的影响.中国药理学通报,2005,21(9):1081-4.
[5]杨梵,黄文起.七氟醚在成人门诊手术中的应用.临床麻醉学杂志,2006,22(3):32-33.
[6]杜金满,郭建荣,任利远,等.罗库溴铵、维库溴铵和阿曲库铵用于全麻气管插管肌松效应的对比研究.实用药物与临床,2006,9(4):21-22.
[7]董国梁,苏醒.罗库溴铵和阿曲库铵肌松作用的对比研究.临床麻醉学杂志,2002,18:640-642.
[8]Moore EW,Hunter JM.The new neuromuscular blocking agents:do they offer any advantages?Br J Anaesth,2001,87(6):912-25.
[9]夏海燕,瞿晓莉.罗库溴铵插管剂量的选择.中华现代临床医学杂志,2003,1:707-708.
[10]Auer U.Clinical observations on the use of the muscle relaxant rocuronium bromide in the dog.Vet J,2007,173(2):422-7.
[11]倪新莉,孟尽海,王宝国,等.不同剂量罗库溴铵在颅脑手术中的肌松效应.临床麻醉学杂志,2005,21:451-453.
[12]蒋鹏,江溢,阐明秀,等.罗库溴铵用于气管插管的临床观察.临床麻醉学杂志,2007,23(8):10.
[13]Mencke T,Knoll H,Schreiber JU,et al.Rocuronium is not associated with morevocal cord injuries than succinylcholine after rapidsequence induction:a randomized,prospective,controlled trial.Anesth Analg,2006,102(3):943-9.
[14]Kuipers JA,Boer F,Olofsen E,et al.Recirculatory pharmacokinetics and pharmacodynamics of rocuronium in patients:the influence of cardiacoutput.Anesthesiology,2001,94(1):47-55.
[15]沈锦春,徐建国,段满林.异氟醚和地氟醚对罗库溴铵肌松作用的影响.临床麻醉学杂志,1999,15(4):905-6.
[16]徐光红,张健.吸入不同浓度的七氟醚对罗库溴铵肌松效应的影响.安徽医科大学学报,2007,42(1):17-18.
[17]Yamaguchi S,Egawa H,Mishio M,et al.Bispectral monitoring during vital capacity rapid inhalation induction with sevoflurane.J Clin Anesth.2003,15(1):24-8.
[18]龙跃,李准民,易礼清,等.新型肌松药-瑞库溴铵、罗库溴铵和顺式阿曲库铵的研究进展.河南医学研究,2006,9,15(3).
[19]Saldien V,Vermeyen KM,Wuyts FL.Target-controlled infusion of rocuronium in infants,children,and adults:a comparison of the pharmacokinetic and pharmacodynamic relationship.Anesth Analg,2003,97(1):44-9.
[20]杭燕南,庄心良,蒋豪,等.当代麻醉学[M].上海:上海科学技术出版社,2002:336-346.
[21]Bock M,Klippel K,Nitsche B,et al.Rocuronium potency and recovery characteristics during steady-state desflurane,sevoflurane,isoflurane or propofol anaesthesia.Br J Anaesth,2000,84:43-7.
[22]冯国辉,李军,张宏.等.不同浓度异氟醚对罗库溴铵肌松作用的影响.中华麻醉学杂志,2003,23(10):734-736.
[23]Reid JE,Breslin DS,Mirakhur RK,et al.Neostigrnine antagonism of rocuronium block during anesthesia with sevoflurane,isoflurane or propofol.Can J Anaesth,2001,48(4):351-5.
[24]杨在启,魏丕红,魏淑明,等.七氟醚、异氟醚对罗库溴铵强化作用的时效关系研究.泰山医学院学报,2007.28:1.
[25]李恒,杨承祥,李卫东,等.安氟醚对大鼠心肌缺血再灌注损伤的保护作用.中国现代医学杂志,2005,15(6):847-857.
[26]Hemmerling TM,Schuettler J,Schwilden H.Desflurane reduces the effective therapeutic infusion rate(ETI) of cisatracuurium more than isoflurane,sevoflurane,or propofol.Can J Anaesth,2001,48(6):532-7.
[27]Kopman AF,Chin WA,Moe J,et al.The effect of nitrous oxide on the dose-respo-nse relationship of rocuronium.Anesth Analg,2005,100(5 ):1343-1347.
[28]张倩,金玄玉,何晓帆.等.异丙酚,七氟醚,异氟醚对罗库溴铵作用时效的影响.中华实用中西医杂志,2006,19(4):25-27.
[29]于森舒,张锐,刘凤娟,等.异氟醚,安氟醚对阿曲库铵的残余肌松作用影响.航空航天医药,2007,18(1):25-26.
[30]de Boer H D,Van Egmond J,van de Pol F,et al.Sugammadex,a new reveral agent for neuromuscular block induced by rocuronium in the anaesthetized Rhesus monkey.Br J Anaesth,2006,96(4):473-9.
[31]Bom A,Mason R,Hope F,et al.Reversal of neuromuscular blochade and simultaneous increase in plasma rocuronium concentration after the intravenous infu- sion of the novel reversal ahent Org25969.Anesthesiology,2003,99(3):632-7.
[32]van Egmond J,van de pol F,Booij L,et al.Time course of action of sugammadex (Org25969) on rocuronium-induced block in the Rhesus monkey,using a simple model of equilibration of cpmplex formation.Br J Anaesth,2006,97(5):681-6.
[33]De Boer H D,van Egmond J,van de pol F,et al.Chemical encapsulation of rocuronium by synthetic cyclodextrinderivatives:reversal of neuromuscular block in anaesthetized Rhesus monkeys.Br J Anaesth,2006,96(2):201-6.
[34]De Boer H D,Van Egmond J,Van ed Pol F,et al.Sugammadex,a new reveral agent for neuromuscular block induced by rocuronium in the anaesthetized Rhesus monkey.Br J Anaesth,2006,96(4):473-91.
[35]Bom A,Mason R,Hope F,et al.The Cyclodextrin derivative Org25969,which forms complexes with steroidal neuromuscular blocking agents,causes selective reversal of normal and profound neuromuscular block.Anesthesiology,2002,95(2):102-6.
[36]Shields M,Giovannelli M,Mirakhur RK,et al.Org25969(sugammdex),a selective relaxant and blinding agent for antagonism of prolongded recuronium-induced neuromuscular block.Br J Anaesth,2006,96(1):36-43.
[37]Iben FS,Kathrine N,Per Bo L,et al.Reversal of rocuronium-induced neuromuscular block by the selective relaxant binding agent sugammadex:adose-finding and safetystudy.A nesthesiology,2006,104(4):667-674.
[38]Gijsenbergh F,Ramael S,Houwing N,et al.First human exposure of Org25969,a novel agent to revense the action of rocuronium bromide.Anesthesiology,2005,103(4):695-703.
[39]Reid JE,Breslin DS,Mirakhur RK,et al.Neostigrnine antagonism of rocuronium block during anesthesia with sevoflurane,isoflurane or propofol.Can J Anaesth,2001,48(4):351-5.
[40]侯长征,冉建,欧阳葆怡,等.地氟醚对新斯的明拮抗罗库溴铵肌松作用的影响.广州医药,2004,35(20):33-36.
[41]杨明华.异氟醚对新斯的明拮抗维库溴铵作用.肿瘤学杂志,2002,8(4):218-219.
[2]雷利明,张文胜,刘进,等.七氟醚的临床研究及进展.四川解剖学杂志,2006,14(3):45-47.
[3]Campagna JA,Miller KW,Forman SA.Mechanisms of actions of inhaled anesthetics,N Engi J Med,2003,22;348(21):2110-2124.
[4]Wu XS,Sun JV,Evers AS,et al.Isoflurane inhibits transmitter release and the presynaptic action potential.Anesthesiology,2004,100(3):470-2.
[5]颜梅,戴体俊.吸入麻醉药镇痛、催眠作用与GABAA受体的关系.中国药理学通报,2004,20:521-523.
[6]Urban BW.Current assessment of targets and theories of anesthesia.Br J Anaesth,2002,89(1):167-83.
[7]李传翔,姚尚龙,聂辉,等.七氟醚对非去极化肌松药与肌肉乙酰胆碱受体作用的影响.中国药理学通报,2005,21-9:1081-4.
[8]Fodale V,Santamaria LB.Laudanosine,an atracurium and cisatracurium metabo- lite.Eur Anaesthesiol,2002,19(7):466-73.
[9]Ma H,Zhuang X.Selection of neuromuscular blocking agents in patients undergoing renal transplantation under general anesthesia.Chin Med J(Engl),2002:115(11):1692-6.
[10]Della Rocca G,Pompei L,Coccia C,et al.Atracuriu m,cisatra curium,vecuronium and rocuronium in patients with renal failure.Minerva Anestesiol,2003:69(7-8):605-11,612,5.
[11]邹伟,王瑞,高椿霖,等.全凭静脉麻醉下持续输注国产阿曲库铵的药效学观察.中国药房,2005,16(12):926-927.
[12]Lallemand MA,Lentschener C,Mazoit JX,et al.Bispectral index changes following etomidate induction of general anesthesia and orotracheal intubation.Br Anaesth,2003,91(3):341-6.
[13]张军,梁伟民,顾华华.等.不同浓度吸入麻醉药对脑电双频指数的影响.临床麻醉学杂志,2002,10,18(10):548-550.
[14]刘威,闻大翔,杭燕南,等.四种中时效非去极化肌松药组胺释放作用的研究.上海第二医科大学学报,2003,23(5):445-8.
[15]刘俊杰,赵俊.现代麻醉学[M],第2版,北京:人民卫生出版社,2000:318-319.
[16]刘利怡,廖旭,薛富善,等.舒芬太尼的药理学和临床应用[J].中国医药导刊,2005,7(6):454-457.
[17]唐红利,耿武军,董冬梅,等.舒芬太尼对鼻内镜手术围拔管期对血流动力学的影响.浙江医学,2007,29(3):262-263.
[18]于布为,薛庆生,罗艳,等.吸入麻醉药物的研究进展.继续医学教育,2007.20(15):26-36.
[19]刘琴湘,许春雷,邹冬玲,等.靶控输注丙泊酚复合硬膜外麻醉在腹腔镜下胆囊切除术中的应用[J].中国新药与临床杂志,2005,24(7):539-542.
[20]吴新民,叶铁虎,岳云,等.国产注射用瑞芬太尼有效性和安全性的评价.中华麻醉学杂志,2003,23(4):245.
[21]赵高峰,张兴安,吴群林,等.靶控输注异丙酚复合瑞芬太尼或芬太尼全静脉麻醉.广东医学,2004,25(7):765.
[22]Miller RD.Academic anesthesia faculty salaries:incentive s,availability,and productivity.Anesth Analg,2005,100(2):487-9.
[23]Paul M,Fokt RM,Kindler CH,et al.Characterizatoion of the interactions between volatile anesthetics and neuromuscular blockers at the muscle nicotinic acetylcholine receptor.Anesth Analg,2002,95(2):362-7.
[24]Dragne A,Varin F,Plaud B,et al,Rocuronium pharmacokinetic relationship under stable propofol or isoflurane anesthesia.Can J Anaesth,2002,49(4):353-60.
[25]Murphy GS,Szokol JW,Franklin M,et al.Postanesthesia careunit recovery times and neuromuscular blocking drugs:A prospective study of orthopedic surgical patients randomized to receive pancuronium or rocuronium.Anesth Analg,2004,98(1):193-200.
[26]杨在启,魏淑明.七氟醚或异氟醚对阿曲库铵血浆靶控.社区医学杂志,2006,4(9):28-29.
[27]McCaul C,Tobin E,Boylan JF,et al.Atracurium is associated with postoperative residual curarization.Br J Anaesth.2002,89(5):766-9.
[28]Fawcett WJ.Atracurium is associated with postoperative residual curarization.Br J Anaesth,2003,90(6):810.
[29]Hayes AH,Mirakhur RK,Breslin DS,et al.Postoperative residual block after intermediate-acting neuromuscular blocking drugs.Anaesthesia,2001,56(4):312-8.
[30]Kopman AF,Zank LM,Ng J,et al.Antagonism of cisatracurium and rocuronium block at a tactile train-of-four count of 2:should quantitative of assessment neuromuscular function be mandatory ?Anesth Analg,2004,98(1):102-6.
[31]Gatke MR,Viby-Mogensen J,Rosenstock C,et al.Postoperative muscle paralysis after rocuronium:less residual block when acceleromyography is used.Acta Anaesthe- siol Scand,2002,46(2):207-13.
[32]Cammu G,de Baerdemaeker L,den Blauwen N,et al.Postoperative residual curarization with cisatracurium and rocuronium infusions.Eur J Anaesthesiol,2002,19(2):129- 34.
[33]Jonsson M,Kim C,Yamamoto Y,et al.Atracurium and vecuronium block nicotine induced carotid body chemoreceptor responses.Acta Anaesthesiol Scand,2002,46(5):488-94.
[34]沈亮,严谨,陆志俊,等.新斯的明拮抗国产阿曲库铵效果及对Q、T 离散度的影响.临床麻醉学杂志,2004,20:387-389.
[1]李德惠,李海波,赵欢,等.琥珀胆碱对罗库溴铵作用的影响.临床麻醉学杂志,2000,16(7):337-339.
[2]庄心良,曾因明,陈伯銮,等.现代麻醉学.第三版.北京:人民卫生出版社,2004,745.
[3]杨保仲,庄心良,赵雪莲,等.肌肉型乙酰胆碱受体在HEK293细胞上的表达.中国药理学通报,2004,20(10):1186-9.
[4]李传翔,姚尚龙,聂辉,等.七氟醚对非去极化肌松药与肌肉乙酰胆碱受体作用的影响.中国药理学通报,2005,21(9):1081-4.
[5]杨梵,黄文起.七氟醚在成人门诊手术中的应用.临床麻醉学杂志,2006,22(3):32-33.
[6]杜金满,郭建荣,任利远,等.罗库溴铵、维库溴铵和阿曲库铵用于全麻气管插管肌松效应的对比研究.实用药物与临床,2006,9(4):21-22.
[7]董国梁,苏醒.罗库溴铵和阿曲库铵肌松作用的对比研究.临床麻醉学杂志,2002,18:640-642.
[8]Moore EW,Hunter JM.The new neuromuscular blocking agents:do they offer any advantages?Br J Anaesth,2001,87(6):912-25.
[9]夏海燕,瞿晓莉.罗库溴铵插管剂量的选择.中华现代临床医学杂志,2003,1:707-708.
[10]Auer U.Clinical observations on the use of the muscle relaxant rocuronium bromide in the dog.Vet J,2007,173(2):422-7.
[11]倪新莉,孟尽海,王宝国,等.不同剂量罗库溴铵在颅脑手术中的肌松效应.临床麻醉学杂志,2005,21:451-453.
[12]蒋鹏,江溢,阐明秀,等.罗库溴铵用于气管插管的临床观察.临床麻醉学杂志,2007,23(8):10.
[13]Mencke T,Knoll H,Schreiber JU,et al.Rocuronium is not associated with morevocal cord injuries than succinylcholine after rapidsequence induction:a randomized,prospective,controlled trial.Anesth Analg,2006,102(3):943-9.
[14]Kuipers JA,Boer F,Olofsen E,et al.Recirculatory pharmacokinetics and pharmacodynamics of rocuronium in patients:the influence of cardiacoutput.Anesthesiology,2001,94(1):47-55.
[15]沈锦春,徐建国,段满林.异氟醚和地氟醚对罗库溴铵肌松作用的影响.临床麻醉学杂志,1999,15(4):905-6.
[16]徐光红,张健.吸入不同浓度的七氟醚对罗库溴铵肌松效应的影响.安徽医科大学学报,2007,42(1):17-18.
[17]Yamaguchi S,Egawa H,Mishio M,et al.Bispectral monitoring during vital capacity rapid inhalation induction with sevoflurane.J Clin Anesth.2003,15(1):24-8.
[18]龙跃,李准民,易礼清,等.新型肌松药-瑞库溴铵、罗库溴铵和顺式阿曲库铵的研究进展.河南医学研究,2006,9,15(3).
[19]Saldien V,Vermeyen KM,Wuyts FL.Target-controlled infusion of rocuronium in infants,children,and adults:a comparison of the pharmacokinetic and pharmacodynamic relationship.Anesth Analg,2003,97(1):44-9.
[20]杭燕南,庄心良,蒋豪,等.当代麻醉学[M].上海:上海科学技术出版社,2002:336-346.
[21]Bock M,Klippel K,Nitsche B,et al.Rocuronium potency and recovery characteristics during steady-state desflurane,sevoflurane,isoflurane or propofol anaesthesia.Br J Anaesth,2000,84:43-7.
[22]冯国辉,李军,张宏.等.不同浓度异氟醚对罗库溴铵肌松作用的影响.中华麻醉学杂志,2003,23(10):734-736.
[23]Reid JE,Breslin DS,Mirakhur RK,et al.Neostigrnine antagonism of rocuronium block during anesthesia with sevoflurane,isoflurane or propofol.Can J Anaesth,2001,48(4):351-5.
[24]杨在启,魏丕红,魏淑明,等.七氟醚、异氟醚对罗库溴铵强化作用的时效关系研究.泰山医学院学报,2007.28:1.
[25]李恒,杨承祥,李卫东,等.安氟醚对大鼠心肌缺血再灌注损伤的保护作用.中国现代医学杂志,2005,15(6):847-857.
[26]Hemmerling TM,Schuettler J,Schwilden H.Desflurane reduces the effective therapeutic infusion rate(ETI) of cisatracuurium more than isoflurane,sevoflurane,or propofol.Can J Anaesth,2001,48(6):532-7.
[27]Kopman AF,Chin WA,Moe J,et al.The effect of nitrous oxide on the dose-respo-nse relationship of rocuronium.Anesth Analg,2005,100(5 ):1343-1347.
[28]张倩,金玄玉,何晓帆.等.异丙酚,七氟醚,异氟醚对罗库溴铵作用时效的影响.中华实用中西医杂志,2006,19(4):25-27.
[29]于森舒,张锐,刘凤娟,等.异氟醚,安氟醚对阿曲库铵的残余肌松作用影响.航空航天医药,2007,18(1):25-26.
[30]de Boer H D,Van Egmond J,van de Pol F,et al.Sugammadex,a new reveral agent for neuromuscular block induced by rocuronium in the anaesthetized Rhesus monkey.Br J Anaesth,2006,96(4):473-9.
[31]Bom A,Mason R,Hope F,et al.Reversal of neuromuscular blochade and simultaneous increase in plasma rocuronium concentration after the intravenous infu- sion of the novel reversal ahent Org25969.Anesthesiology,2003,99(3):632-7.
[32]van Egmond J,van de pol F,Booij L,et al.Time course of action of sugammadex (Org25969) on rocuronium-induced block in the Rhesus monkey,using a simple model of equilibration of cpmplex formation.Br J Anaesth,2006,97(5):681-6.
[33]De Boer H D,van Egmond J,van de pol F,et al.Chemical encapsulation of rocuronium by synthetic cyclodextrinderivatives:reversal of neuromuscular block in anaesthetized Rhesus monkeys.Br J Anaesth,2006,96(2):201-6.
[34]De Boer H D,Van Egmond J,Van ed Pol F,et al.Sugammadex,a new reveral agent for neuromuscular block induced by rocuronium in the anaesthetized Rhesus monkey.Br J Anaesth,2006,96(4):473-91.
[35]Bom A,Mason R,Hope F,et al.The Cyclodextrin derivative Org25969,which forms complexes with steroidal neuromuscular blocking agents,causes selective reversal of normal and profound neuromuscular block.Anesthesiology,2002,95(2):102-6.
[36]Shields M,Giovannelli M,Mirakhur RK,et al.Org25969(sugammdex),a selective relaxant and blinding agent for antagonism of prolongded recuronium-induced neuromuscular block.Br J Anaesth,2006,96(1):36-43.
[37]Iben FS,Kathrine N,Per Bo L,et al.Reversal of rocuronium-induced neuromuscular block by the selective relaxant binding agent sugammadex:adose-finding and safetystudy.A nesthesiology,2006,104(4):667-674.
[38]Gijsenbergh F,Ramael S,Houwing N,et al.First human exposure of Org25969,a novel agent to revense the action of rocuronium bromide.Anesthesiology,2005,103(4):695-703.
[39]Reid JE,Breslin DS,Mirakhur RK,et al.Neostigrnine antagonism of rocuronium block during anesthesia with sevoflurane,isoflurane or propofol.Can J Anaesth,2001,48(4):351-5.
[40]侯长征,冉建,欧阳葆怡,等.地氟醚对新斯的明拮抗罗库溴铵肌松作用的影响.广州医药,2004,35(20):33-36.
[41]杨明华.异氟醚对新斯的明拮抗维库溴铵作用.肿瘤学杂志,2002,8(4):218-219.