老年腰椎结核合并骨质疏松患者麻醉诱导应用顺式阿曲库铵的药效学研究

发布时间：2019-03-14 18:13

【摘要】：目的比较老年腰椎结核合并骨质疏松患者与普通老年腰椎手术患者麻醉诱导时顺式阿曲库铵药效学的差异。方法选择2012年6月~2013年6月我院骨科老年腰椎结核合并骨质疏松患者(A组)、老年腰椎手术合并骨质疏松的患者(B组),老年腰椎结核手术患者(C组)和腰椎间盘突出手术患者(D组)各20例进行研究。所有患者均于术前30 min肌肉注射阿托品0.5 mg。4组患者麻醉诱导均采用静脉注射咪达唑仑0.05 mg/kg、丙泊酚2 mg/kg、芬太尼5μg/kg和注射单次剂量顺式阿曲库0.15 mg/kg,观察记录诱导期间患者血流动力学变化,同时应用肌松监测仪记录各组起效时间、第一次肌颤搐刺激T1恢复到25%、75%、90%的时间及恢复指数。结果诱导期间A、B、C、D各组之间的血压、心率变化及肌松药的起效时间之间的差异无统计学意义(P0.05),A组注射相同剂量的顺式阿曲库铵后神经肌肉阻滞的25%、75%、90%的恢复时间为34.1±9.5 min,45.7±5.6 min,51.8±5.1 min;B组注射相同剂量的顺式阿曲库铵后神经肌肉阻滞的25%、75%、90%的恢复时间为32.2±7.4 min,62.4±2.7 min,63.1±6.4 min;C组注射相同剂量的顺式阿曲库铵后神经肌肉阻滞的25%、75%、90%的恢复时间为33.5±5.4 min,43.6±6.1 min,49.9±6.7 min;D组注射相同剂量的顺式阿曲库铵后神经肌肉阻滞的25%、75%、90%的恢复时间为44.1±7.0 min,58.7±7.6 min,64.9±5.3 min。A组较B、D组的恢复时间显著缩短(P0.05)。而A组注射相同剂量的顺式阿曲库铵后神经肌肉阻滞的恢复时间与C组之间差异无统计学意义(P0.05)。结论腰椎结核患者麻醉诱导时应用顺式阿曲库铵可显著降低其作用时间,而单纯骨质疏松患者麻醉诱导时不会影响应用顺式阿曲库铵的作用时间。
[Abstract]:Objective to compare the pharmacodynamics of cis-atracurium in the induction of anesthesia between elderly patients with lumbar tuberculosis complicated with osteoporosis and normal elderly patients undergoing lumbar surgery. Methods from June 2012 to June 2013, aged patients with lumbar tuberculosis complicated with osteoporosis in orthopedics department (group A) and aged patients with lumbar surgery combined with osteoporosis (group B) were selected. 20 elderly patients with lumbar tuberculosis (group C) and 20 patients with lumbar disc herniation (group D) were studied. All patients were given midazolam 0.05 mg/kg, propofol 2 mg/kg, intravenously 30 min intramuscular injection of atropine 0.5 mg.4 before operation. The hemodynamic changes during induction were observed with fentanyl 5 渭 g / kg and single dose of cis-atracurium 0.15 mg/kg, and the onset time of each group was recorded with muscle relaxation monitor. The T1 of the first tremor convulsive stimulation was restored to 25%. 75%, 90% time and recovery index. Results there was no significant difference in blood pressure, heart rate and onset time of muscle relaxant between groups A, B, C, D during induction (P0.05), A group was 25% of neuromuscular block after injection of the same dose of cis-atracurium), and there was no significant difference in blood pressure, heart rate and onset time of muscle relaxant between groups A, B, C, D. 75%, 90% recovery time 34.1 卤9.5 min,45.7 卤5.6 min,51.8 卤5.1 min; In group B, the recovery time of neuromuscular block was 32. 2 卤7. 4 min,62.4 卤2. 7 min,63.1 卤6. 4 min; after injection of the same dose of cis-atracurium at 25%, 75% and 90% respectively. In group C, the recovery time of neuromuscular block was 33. 5 卤5. 4 min,43.6 卤6. 1 min,49.9 卤6. 7 min; after injection of the same dose of cis-atracurium at 25%, 75% and 90% respectively. In group D, neuromuscular block was 25%, 75%, 90% recovery time was 44.1 卤7.0 min,58.7 卤7.6 min,64.9 卤5.3 min.A after injection of the same dose of cis-atracurium, and the recovery time of group D was 44.1 卤7.0 min.A 卤7.6 min.A 卤5.3 min.A. The recovery time in group D was significantly shorter than that in group D (P0.05). There was no significant difference in the recovery time of neuromuscular block between group A and group C after injection of the same dose of cis-atracurium (P0.05). Conclusion the application of cis-atracurium in anesthesia induction of lumbar tuberculosis patients can significantly reduce its action time, but it will not affect the action time of orthoatracurium during anesthesia induction in patients with simple osteoporosis. [WT5 "HZ] conclusion [WT5" BZ] [WT5 "BZ]
【作者单位】：河北北方学院;解放军第309医院麻醉科;泰安中心医院小儿外科;
【基金】：全军医学科技“十二五”面上项目(CWS12J084)
【分类号】：R614

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