摘要
目的观察盐酸右美托咪啶预注及持续输注对老年和中青年患者顺苯磺酸阿曲库铵肌松效应的影响。方法全麻下行腹部手术的老年及中青年患者各40例,按是否使用盐酸右美托咪啶随机均分为老年右美托咪啶组(DE组,20例)、老年对照组(CE组,20例);中青年右美托咪啶组(DY组,20例)、中青年对照组(CY组,20例)。DE组、DY组患者按0.5μg·kg-1的负荷剂量给予盐酸右美托咪啶,随后开始麻醉诱导同时以0.4μg·kg-1·h-1持续整个手术过程;CE组、CY组给予等量的0.9%氯化钠注射液。静脉注射咪唑安定、丙泊酚、芬太尼及顺苯磺酸阿曲库铵0.15 mg·kg-1行全麻诱导,持续输注丙泊酚、瑞芬太尼和顺苯磺酸阿曲库铵维持麻醉。观察4组患者顺苯磺酸阿曲库铵肌松效应的变化。结果 4组患者肌松起效时间比较差异无统计学意义(均P>0.05)。阻滞维持时间DE组[(61.1±8.9)min]、DY组[(53.6±9.3)min],分别长于CE组[(49.9±5.8)min]、CY组[(44.8±6.4)min](均P<0.01),且DE组、CE组分别长于DY组、CY组(均P<0.05)。顺苯磺酸阿曲库铵的维持用量DE组、DY组分别显著少于CE组、CY组(均P<0.05)。结论老年患者顺苯磺酸阿曲库铵阻滞维持时间较中青年显著延长,维持用量减少。全麻期间盐酸右美托咪啶预注及持续泵注并不能缩短顺苯磺酸阿曲库铵起效时间,但可以明显延长其作用时间,减少用量。
Objective To observe the effects of dexmedetomidine hydrochloride on the cisatracurium-induced neuromuscular blockade in geriatric,young and middle-aged patients. Methods Forty elderly patients and forty young and middle-aged patients undergoing elective abdominal surgery under general anesthesia were randomly divided into 4 groups（ n = 20each） ： elderly dexmedetomidine hydrochloride group（ group DE）,elderly control group（ group CE）,young and middle-aged dexmedetomidine group（ group DY） and young and middle-aged control group（ group CY）.In groups DE and DY,a loading dose of 0.5 μg·kg^-1dexmedetomidine was intravenously infused over 10 min before induction of anesthesia,respectively,followed by infusion at a rate of 0.4 μg·kg^-1·h^-1until the end of surgery.Equal volume of 0.9% sodium chloride was given in groups CE and CY.Anesthesia was induced with midazolam,fentanyl,propofol and cisatracurium 0.15 mg·kg^-1.Four groups were maintained with infusion of propofol and remifentanil. Neuromuscular blockade was maintained with continuous cisatracurium infusion in the four groups and was monitored with TOF-Watch SX acceleromyography at the adductor pollicis. The onset time,TOF no reaction period,duration of action,the amount of cisatracurium consumption,and the spontaneous recovery index（ T125% to 75%） were recorded. Results The four groups were comparable in the demographic data.Intubation conditions,the onset time and recovery index were not significantly different among the four groups. The duration of blockade action in groups DE and DY was（ 61. 1 ±8.9） min and（ 53.6±9.3） min,which was significantly longer than that in group CE [（ 49.9±5.8） min]and group CY [（ 44.8±6.4） min]（ P〈0.01）.The duration of blockade action was significantly longer in groups DE and CE than in groups DY and CY（ P〈0.05）.The amount of cisatracurium consumption in groups CE and CY was significantly higher than that in groups DE and DY（ P〈0.05）. Conclusion The neuromuscular blockade is longer and the requirement of cisatracurium is less in elderly patients than in young and middle-aged patients.Continuous infusion of dexmedetomidine hydrochloride can＇t accelerate the onset time of cisatracurium.But duration of action is prolonged and the amount of cisatracurium consumption is lower in patients with infusion of dexmedetomidine hydrochloride.
出处
《医药导报》
CAS
2016年第4期337-340,共4页
Herald of Medicine
基金
2015年秦皇岛市级科技计划项目(201502A070)
作者简介
刘沁爽（1976-），女，河北张家口人，副主任医师，硕士，研究方向：临床麻醉。电话：0335-5908233，E-mail：lqslsn@sina．com。
