摘要：
Objective To evaluate the efficacy of clemastine fumarate in antagonizing atracuriuminduced release of histamine in the patients undergoing surgery under general anesthesia.Methods Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 21-59 yr,with body mass index of 17-26 kg/m2,scheduled for elective modified radical mastectomy,were divided into 2 groups (n=40 each) using a random number table:control group (group C) and clemastine fumarat group (group CF).Clemastine fumarate 2 mg was injected intramuscularly at 20 min before induction of anesthesia.Anesthesia was induced with iv midazolam 0.1 mg/kg,etomidate 0.3 mg/kg,fentanyl 4-6 μg/kg and atracurium 0.8 mg/kg.The patients were mechanically ventilated after insertion of the larygeal mask airway.Anesthesia was maintained with inhalation of 2％ sevoflurane.Before administration of clemastine fumarate,at 20 min after administration,immediately before administration of atracurium,and at 2,5,10 and 20 min after administration of atracurium,arterial blood samples were taken for determination of plasma histamine concentrations,and the peak airway pressure and degree of cutaneous color were recorded.The development of histaminemia and adverse cardiovascular events was assessed.Steward recovery scores and Ramsay sedation scores were recorded at 10 min after removal of the laryngeal mask airway.Results The incidence of histaminemia was 60％ and 8％ in C and CF groups,respectively.Compared with group C,the plasma histamine concentrations,incidence of histaminemia,degree of cutaneous color,and incidence of hypotension and tachycardia were significantly decreased (P＜0.05),and no significant change was found in the peak airway pressure,Steward recovery scores and Ramsay sedation scores in group CF (P＞0.05).Conclusion For atracurium-induced release of histamine in the patients undergoing surgery under general anesthesia,clemastine fumarate 2 mg injected intramuscularly before operation can not only antagonize histamine at H1 level,but also reduce histamine release,and exerts no influence on recovery from anesthesia and produces good antihistamine efficacy.%目的 评价富马酸氯马斯汀用于拮抗阿曲库铵诱发全麻手术患者组胺释放的效应.方法 择期行乳腺癌改良根治术患者80例,年龄21 ～59岁,BMI 17～26 kg/m2,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将其分为2组(n=40):对照组(C组)和富马酸氯马斯汀组(CF组),CF组于麻醉诱导前20 min肌肉注射富马酸氯马斯汀2 mg.依次静脉注射咪达唑仑0.1 mg/kg、依托咪酯0.3mg/kg、芬太尼4～6 μg/kg和阿曲库铵0.8 mg/kg麻醉诱导后置入喉罩,行机械通气,吸入2％七氟醚维持麻醉.分别于富马酸氯马斯汀给药前、给药后20 min、阿曲库铵给药前即刻、给药后2、5、10、20 min时采集动脉血样,测定血浆组胺浓度,记录气道峰压和局部皮肤颜色程度,评估高组胺血症和心血管事件发生情况;拔除喉罩后10 min时记录Steward苏醒评分与Ramsay镇静评分.结果 C组和CF组高组胺血症发生率分别为60％和8％;与C组比较,CF组血浆组胺浓度、高组胺血症发生率、局部皮肤颜色程度、低血压和心动过速的发生率明显降低(P＜0.05),气道峰压、Steward苏醒评分和Ramsay镇静评分比较差异无统计学意义(P＞0.05).结论 对于阿曲库铵诱发全麻手术患者的组胺释放,术前肌肉注射富马酸氯马斯汀2 mg,不仅可在H1受体水平拮抗组胺,还可减少组胺释放量,且不干扰麻醉恢复,可产生良好的抗组胺效应.
