运用闭环靶控技术研究右美托咪定对顺苯阿曲库铵肌松效应的影响

摘要

Objective:To investigate the effect of dexmedetomine ( DEX) on close-loop muscle relax-ant injection system using cisatracurium ( CIS) in laparoscopic cholecystectomy ( LC) . Methoyds:60 patients undergoing LC under general anesthesia with tolal intravenous anesthesia were randomly divided into three groups:group A, normal saline ( NS)+3ED95CIS; group B, DEX+3ED95CIS; group C, DEX+4ED95CIS 20 case in each group. In group B and C, a bolus close of 1.0μg/kg DEX was infused before 15 minutes of in-duction, followed by continous infusion of 0.5μg/kg/h untill 20 min before the operation ended. Normal saline was infused in the same way in group A. The onset time, intubation condition, the first-time to add medicine, clinic effect time, the time from stopped close-loop muscle relaxant to recovery of TOF to 0.2,0.5,0.7,0.9, and recovery index ( RI) of CIS. Result:There were no statistical significant on onset time, intubation condi-tion, the first time to add medicine, clinical cluration, the time from stopped close-loop muscle relaxant to re-covery of TOF to 0.2,0.5,0.7,0.9 and RI of CIS in groupAand group B. Comparison between group C and group A, onset time of group C was shorter than in group A (P<0.05), and first add medicine time longer than group A ( P<0.05) . Comparison between group B and group C, onset time of group C shorter than group B, first add medicine time longer than group B ( P<0.05) . The intubation condition in group C was better than in group B ( P<0.05) . Conclusion:DEX can not affect metablism and effect of CIS with closed-loop muscle relaxant injection, but it can improve the condition of intubation. Use DEX conbined with CIS was safe to the patient.%目的:应用顺苯阿曲库铵(cisatracurium CIS)闭环靶控技术研究持续应用右美托咪定(dexmedetomidine DEX)对顺苯阿曲库铵肌松效应的影响.方法:选择ASA分级Ⅰ~Ⅱ级腹腔镜胆囊切除手术患者60例,年龄18~55岁,手术时间<2h,行全凭静脉麻醉,随机分为三组,每组20例,A组:NS(生理盐水)+3ED95 CIS;B组:DEX+3ED95 CIS;C组:DEX+4ED95 CIS.B组、C组患者从全麻诱导前15min开始预注DEX 1.0μg/kg负荷量,插管后以0.5μg/kg/h维持,至手术结束前20min停止泵注;对照组A组从术前15min开始泵注等量的生理盐水至手术结束前20min.术中均使用闭环靶控输注CIS维持肌松.记录比较各组CIS的起效时间、气管插管条件评定、首次增药时间、临床作用时间、闭环肌松停药至TOF恢复到0.2、0.5、0.7、0.9时间、恢复指数.结果:B组与A组比较,CIS的起效时间、气管插管条件评定、首次增药时间、临床作用时间、闭环肌松停药至TOF恢复到0.2、0.5、0.7、0.9时间、恢复指数等数据对比差异无统计学意义(P>0.05);C组与A组比较,C组CIS的起效时间小于A组(P<0.05)、首次增药时间大于A组(P<0.05),气管插管条件优于A组;B组与C组比较,C组CIS的起效时间小于B组(P<0.05)、首次增药时间大于B组(P<0.05),气管插管条件优于B组.结论:DEX不会影响CIS的肌松效应,不会延长其代谢时间,两者联合使用安全、有效,但CIS会随其剂量增加缩短起效时间并改善插管条件.