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动脉二氧化碳分压对罗库溴铵肌松恢复和拮抗效果的影响
The effects of arterial carbon dioxide on the recovery of neuromusuclar blockade of rocuronium and its antagonism.

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DOI:
作者:
滕凌雅,李士通
TENG Lingya, LI Shitong,
作者单位:
上海市第一人民医院
Department of Anesthesiology, Shanghai First People’s Hospital, Shanghai Jiaotong University, Shanghai 200080
关键词:
罗库溴铵；二氧化碳分压；肌松，恢复
rocuronium; PaCO2; neuromuscular blockade；recovery
摘要:
【摘要】 目的：观察动脉血二氧化碳分压对罗库溴铵肌松恢复和拮抗效果的影响。方法：选择60例ASA I-II级成年择期全麻妇科手术患者，随机分为四组： I组（低PaCO230～35mmHg，肌松自然恢复）；II组（ 高PaCO245～50mmHg，自然恢复）；III组（低PaCO2，拮抗肌松）；IV组（高PaCO2，拮抗），各15例。使用TOF-watch加速度仪监测肌松。异丙酚、芬太尼和罗库溴铵0.6mg/kg行全麻诱导气管插管，术中T1恢复至25%追加罗库溴铵0.15mg/kg。术毕观测从T1 25%到T1 75%（恢复指数）和到TOFR0.9的恢复时间。拮抗组在T1 25%时予新斯的明20ug/kg和阿托品0.5mg拮抗。结果：四组病人年龄、BMI指数、麻醉药用量、麻醉持续时间、血流动力学变化均无显著性差异（p>0.05）。I、II、III与IV组恢复指数分别为13.12±2.65、18.6±6.58、5.39±2.43和8.87±5.41分钟，从T1 0.25至TOFR0.9的恢复时间分别为26.35±6.04、34.58±6.58、13.28±5.49和17.10±4.64分钟。II组的恢复指数与恢复时间较I组明显延长（p<0.01），IV组较III组也延长（p<0.05）。结论：动脉二氧化碳升高使罗库溴铵的自然恢复和小剂量新斯的明拮抗后的恢复时间均有延长。
【Abstract】Objective To investigate the effects of the arterial blood carbon dioxide on the recovery of neuromusuclar blockade of rocuronium and the antagonistic effect of neostigmine. Methods Sixty patients of Gynecology of ASA grade I-II undergoing selective operation under general anesthesia were randomly divided into four groups (n=15 each): group I (low PaCO2, 30～35mmHg, spontaneously recovery of neuromusuclar blockade of rocuronium); group II (high PaCO2, 45～50mmHg, spontaneously recovery); group III (low PaCO2, antagonizing neuromusuclar blockade of rocuronium with neostigmine); group IV (high PaCO2, antagonizing). Neruomuscular blockade was evaluated by TOF-watch accelerograph. General anesthesia was induced with intravenous propofol, fentanyl and rocuronium 0.6mg/kg. When T1 recovered to 25%，rocuronium 0.15mg/kg was injected. After the operation, the residual neuromuscular blockade was antagonized with atropine 0.5mg and neostigmine 0.02mg/kg in antagonism groups when the T1 reaching 25%.The recovery times of T1 from 25% to 75%(recovery index) and to TOFR 0.9 was recorded. Results There were no significant differrences among four groups with respect to age, body weight and height, BMI index, total consumption of anesthetics, anesthesia duration and hemodynamic parameters. The recovery index in four groups were 3.12±2.65、18.6±6.58、5.39±2.43 and 8.87±5.41 min, respectively. The recovery times from T1 25% to TOFR 0.9 were 26.35±6.04、34.58±6.58、13.28±5.49 and 17.10±4.64 min, respectively. The recovery index and recovery time in group II was much longer than those in group I（p<0.01）, so was that in group IV than in group III（p<0.05） Conclusion The elevated arterial carbon dioxide prolongs the spontaneously recovery of neuromuscular blockade of rocuronium, as well as the recovery after antagonized with small doses of neostigmine.

 

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