| 摘要: |
| 目的:比较不同剂量顺式阿曲库铵和罗库溴铵用于全麻诱导气管插管的效果。方法:60例全麻择期手术ASAⅠ～Ⅱ级患者,随机分为罗库溴铵(0.6 mg/kg)组(A组,n=20)、2倍ED95剂量的顺式阿曲库铵(0.1 mg/kg)组(B组,n=20)、3倍ED95剂量的顺式阿曲库铵(0.15 mg/kg)组(C组,n=20)。麻醉诱导用咪达唑仑、依托咪酯和芬太尼。加速度仪监测神经肌肉功能。采用4个成串刺激(TOF)方式,以麻醉前T1颤搐值(%)作为判断指标,待T1稳定（100%）后10 s内快速静脉注射肌松药。同时予纯氧面罩吸入2 min后行气管插管。记录患者入室、插管前、插管后1、2、3、4、5、10、15 min的收缩压、舒张压和心率,观察插管条件、能否顺利进行气管插管、首次剂量后自行恢复时间以及术中、术后不良反应和呼吸系统并发症发生情况。结果:3组气管插管后15 min内血流动力学变化比较无统计学差异(P>0.05)。A、B、C组最大阻滞分别是(99.4±2.7)%、(99.1±1.9)%、(99.9±0.3)%,无统计学差异(P>0.05);起效时间分别为(1.9±1.1)、(3.6±2.1)、(3.3±1.5) min,A组起效时间明显短于B组和C组(P<0.05);临床作用时间分别为(35.7±11.6)、(35.2±13.0)、(50.9±15.1) min,A组临床作用时间显著短于C组(P<0.05),与B组比较无统计学差异(P>0.05)。A组声门暴露情况明显优于B组和C组(P<0.05);插管一次成功率3组间无统计学差异(P>0.05)。结论:罗库溴铵用于全麻诱导气管插管的起效时间、声门暴露效果优于顺式阿曲库铵,能够提供更好的插管条件。 |
| 关键词: 顺式阿曲库铵 罗库溴铵 全麻诱导气管插管 神经肌肉阻滞 |
| DOI：10.3724/SP.J.1008.2009.0903 |
| 投稿时间：2009-02-20修订日期：2009-05-11 |
| 基金项目: |
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| Cisatracurium versus rocuronium in tracheal intubation for general anesthesia |
| ZHA Yan-ping,LI Jin-bao,DENG Xiao-ming* |
| (Department of Anesthesiology,Changhai Hospital,Second Military Medical University,Shanghai 200433,China) |
| Abstract: |
| Objective:To compare the efficiencies of cisatracurium and rocuronium during tracheal intubation for general anesthesia.Methods:Sixty ASA Ⅰ-Ⅱ patients undergoing elective surgery were randomly divided into 3 groups in which patients received a single bolus of rocuronium 0.6 mg/kg (A group,n=20),cisatracurium 0.1 mg/kg (B group,n=20),or 0.15 mg/kg (C group,n=20).Anesthesia was induced with midazolam,etomidate, and fentanyl.Neuromuscular function was assessed using accelerography with TOF.First twitch (T1) was used as the study parameter.Patients received a rapid bolus administration of study drugs within 10 seconds after T1 became stable at 100%; meanwhile,mask oxygen inhalation was offered for 2 min and then intubation was carried out.The systolic pressure,diastolic pressure, and heart rate were recorded at baseline level,before and 1,2,3,4,5,10,and 15 min after intubation.The intubation conditions were assessed.Whether intubation could be carried out successfully or not and T1 25% recovery time after the initial bolus were also recorded.The adverse effects and respiratory complication during operation and after operation were observed.Results:The hemodynamic changes within 15 min after intubation were not significantly different compared with those before induction in 3 groups (P>0.05).Maximal neuromuscular block rates in group A,B, and C were (99.4±2.7)%,(99.1±1.9)%,and (99.9±0.3)%,respectively,with no significant differences found between the three groups (P>0.05); the onset time periods of the 3 groups were (1.9±1.1) min,(3.6±2.1) min,and (3.3±1.5) min,respectively,with that of group A significantly shorter than those of B and C groups (P<0.05); the time periods of clinical effects were (35.7±11.6) min,(35.2±13.0) min,and (50.9±15.1) min,respectively,with that of group A significantly shorter than that of group C (P<0.05) and with no significant difference found between group A and group B (P>0.05).The glottis exposure degree in group A was significantly better than that of B and C groups (P<0.05).The successful rates of initial intubation were similar between the three groups (P>0.05).Conclusion:Rocuronium is superior to cisatracurium in induction intubating for general anesthesia in terms of clinical effect time and glottis exposure degree,and it can provide better intubating conditions. |
| Key words: cisatracurium rocuronium tracheal intubation of general anesthesia neuromuscular block |
