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七氟醚对小剂量新斯的明拮抗罗库溴铵残余肌松的影响
Influence of sevoflurane on antagonism of rocuronium-induced residual neuromuscular blockade with small dose of neostigmine

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DOI:
作者:
周洁 李士通
ZHOU Jie, 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:
残余肌松；新斯的明；罗库溴铵；七氟醚
residual neuromuscular blockade； neostigmine； rocuronium； sevoflurane
摘要:
摘要：目的 观察小剂量新斯的明拮抗罗库溴铵残余肌松作用的效果，并比较丙泊酚和七氟醚维持麻醉对其的影响。方法 选择60例择期全麻手术病人，随机分为4组（n=15），分别为丙泊酚维持麻醉术后肌松不拮抗组（Pc）；丙泊酚维持肌松拮抗组（Pn）；七氟醚维持肌松不拮抗组（Sc）；七氟醚维持肌松拮抗组（Sn）。咪达唑仑、芬太尼、丙泊酚和罗库溴铵0.6mg/kg麻醉诱导气管插管，术中间断追加罗库溴铵0.15mg/kg。Pc、Pn组静脉持续泵注丙泊酚4-10mg/(kg.h)，Sc、Sn组吸入1-1.5MAC的七氟醚。采用加速度肌松监测仪监测4个成串刺激的比值(TOFR)。术后Pc、Sc组自然恢复，Pn、Sn组TOFR恢复至0.7时，静脉注射新斯的明20ug/kg和阿托品10ug/kg。监测TOFR由0.7恢复至0.9的时间、心动过缓及术后6小时和24小时内恶心呕吐的发生状况。结果 Pc 、Pn、Sc和Sn组TOFR由0.7恢复至0.9的时间分别为13.3±4.5、2.9±0.9、16.6±5.3和4.2±2.1分钟。Sc组较Pc组延长（p<0.05），Pn、Sn组较Pc、Sc组显著缩短（p<0.01）,各组均未发生心动过缓，术后恶心呕吐的发生率各组无统计学差异。结论 使用小剂量新斯的明拮抗罗库溴铵的残余肌松，效果确切，副作用不增加。七氟醚吸入维持麻醉时残余肌松的自然恢复慢，更应使用小剂量新斯的明拮抗。
Abstract: Objective To observe the antagonistic effect of small dose of neostigmine on rocuronium-induced residual neuromuscular blockade, and compare the influence of propofol and sevoflurane anesthesia on the recovery of residual neuromuscular blockade．Methods Sixty patients for elective surgeries were randomly divided into 4 groups (n=15)：propofol infusion for anesthesia maintenance and no antagonism for residual neuromuscular blockade of rocuronium (Pc); propofol maintenance with antagonism of rocuronium (Pn); sevoflurane inhalation for anesthesia maintenance and without antagonism of rocuronium (Sc); sevoflurane with antagonism of rocuronium (Sn). Patients were induced and intubated with midazolam，fentanyl, propofol and 0.6mg/kg rocuronium .Bolus doses of 0.15 mg/kg rocuronium were injected as clinically required during surgery. Anesthesia was maintained with propofol at a rate of 4-10 mg/(kg.h) in groups Pc and Pn, and sevoflurane of 1-1.5 MAC in groups Sc and Sn. The train-of-four ratio(TOFR) was monitored by acceleromyography. When TOFR recovered to 0.7 after operation, neostigmine 20 μg/kg and atropine 10 μg/kg were administrated in group Pn and group Sn. In group Pc and group Sc, neuromuscular function was allowed to recover spontaneously. The interval of TOFR recovery from 0.7 to 0.9 was recorded. Bradycardia and postoperative nausea and vomiting in 6 h and 24 h were also observed．Results The intervals of TOFR recovery from 0.7 to 0.9 in Pc, Pn, Sc and Sn group were 13.3±4.5, 2.9±0.9, 16.6±5.3 and 4.2±2.1 minutes, respectively. The interval of recovery in group Sc was significantly longer than that in group Pc (P<0.05). The intervals of recovery in groups Pn and Sn were significantly shorter than those in groups Pc and Sc, respectively (both P<0．01). There was no bradycardia in the four groups, and there was no significant difference in the incidence of postoperative nausea and vomiting in 6 h and 24 h among the four groups (P>0.05)．Conclusion Antagonism of rocuronium-induced residual neuromuscular blockade with small dose of neostigmine (20 μg/kg) contributed to better reversal of neuromuscular blockade without more adverse events. Small dose of neostigmine is more necessary to antagonize residual neuromuscular blockade when anesthesia is maintained with sevoflurane, with which the interval of spontaneous recovery is longer.

 

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