三种加快顺式阿曲库铵起效时间方法的比较研究

发布时间：2018-05-09 21:51

本文选题：顺式阿曲库铵 + 起效时间　；参考：《遵义医学院》2017年硕士论文

【摘要】：目的:比较三种常用加快顺式阿曲库铵(Cis)起效时间的方法,寻找起效最快且插管条件最优的方法,为临床工作中合理使用Cis提供理论参考。方法:选取拟在全身麻醉下行择期手术的患者120例,美国麻醉医师协会(ASA)评级为Ⅰ~Ⅱ级,年龄:18~65岁,体质指数(BMI):18.5~24.9kg/m2,Mallampati分级:Ⅰ~Ⅱ级,非困难气道且无反流误吸高风险,无发热、严重贫血、药物食物过敏,无肝、肾、心肺系统疾患,近期未服用影响肌松剂作用的药物,术前无严重高血压,心率:60-110次/min,术前3个月监测肌松部位无手术、外伤或穿刺史。采取随机数字表法将120例拟观察的受试者随机均分为4组,对照组(C组)、罗库溴铵预注组(R组)、联合应用麻黄碱组(E组)以及大剂量组(L组),每组30例。各组全麻诱导均采取静脉推注盐酸戊乙奎醚0.01 mg/kg,咪达唑仑0.05 mg/kg,芬太尼4μg/kg,待患者意识消失后完成肌松监测仪定标,R组、E组分别给予罗库溴铵0.06mg/kg或麻黄碱70μg/kg,C组与L组则给予0.9%Na Cl做对照,四组于相同时点给予依托咪酯0.3mg/kg,最后C组、R组、E组、L组分别按0.15mg/kg、0.14mg/kg、0.15mg/kg、0.20mg/kg静脉推注Cis。采用四个成串刺激模式(TOF)予以监测肌松变化。麻醉维持采用静脉泵入瑞芬太尼(0.025~0.4μg·kg-1·min-1)及丙泊酚(4~12 mg·kg-1·h-1),吸入七氟烷(0.6~1.0 MAC)。记录病人入室稳定后(T1)、气管插管前(T2)、插管即刻(T3)、气管插管后1min(T4)、2min(T5)、3min(T6)、4min(T7)、5min(T8)时的平均动脉压(MAP)、心率(HR)、动脉血氧饱和度(Sp O2);记录起效时间(从肌松剂注射结束到TOF计数为0的时间)、持续时间(从肌松剂注射结束到TOF计数恢复到2的时间)、气管插管即刻TOFr值;评估气管插管的条件并计算气管插管优良率;观察病人麻醉期间是否发生皮肤潮红、气管痉挛以及心律失常等不良反应。结果:本试验最终纳入104例(C组、E组各27例,R组及L组各25例)。各组患者在性别、年龄、BMI、术前体温上的比较,差异无统计学意义(P0.05)。各组在麻醉诱导期间的不同时点的MAP有差别(F=76.116,P=0.000),与其他时点相比较,T3时MAP明显增高;在T3时点与R组相比,E组MAP显著增高,差异有统计学意义(P=0.033);不同时点的MAP在不同随机分组上无差别(F=1.854,P=0.12);各组MAP在不同时点的变化趋势上无差别(F=0.535,P=0.659);各组在不同时点上的心率有差别(F=45.319,P=0.000),与其它时点相比,T3时HR明显增高,T2和T8时明显降低;不同时点的HR在不同随机分组上无差别(F=1.707,P=0.27);各组HR在不同时点的变化趋势上无差别(F=1.738,P=0.164)。各组不同时点上的Sp O2有差别(F=209.549,P=0.000),与其它时点相比,T1时显著降低;不同时点的Sp O2在不同随机分组上无差别(F=0.792,P=0.731);各组Sp O2在不同时点的变化趋势上无差别(F=0.299,P=0.826)。与C组相比,其余各组在起效时间都显著加快,差异具有统计学意义(P0.05)。与E组相比,R组起效时间更快,差异有统计学意义(P=0.003);L组与E组、R组分别比较,差异均无统计学意义(P0.05)。在肌松药持续时间上,与其它各组相比,L组显著延长,差异有统计学意义(P0.05),其余三组间比较差异无统计学意义(P0.05)。气管插管时的TOFr值,与其余组别相比,R组明显减小,差异有统计学意义(P0.05);与C组、E组比较,L组的TOFr值减小,差异有统计学意义(P0.05);而C、E组之间的比较,差异无统计学意义(P0.05)。各组受试者插管条件的比较,四组间差异无统计学意义(P0.05)。各组受试者在全麻诱导及维持期间均未发生不良反应。结论:在三种加快顺式阿曲库铵起效时间的方法中,罗库溴铵预注法加快起效时间的效果最佳,获得插管条件优良,诱导期平稳,无显著不良反应,可在临床大多数患者中推广使用。
[Abstract]:Objective: To compare the three methods used to speed up the onset time of CIS atracurium (Cis), to find the fastest and best intubation conditions, and to provide theoretical reference for the rational use of Cis in clinical work. Methods: 120 patients who were planned to undergo elective surgery under general anesthesia were selected and the American anesthesiologist Association (ASA) was rated as grade I ~ II, age: 1 8~65 years, body mass index (BMI): 18.5~24.9kg/m2, Mallampati classification: Grade I ~ II, non difficult airway and no reflux aspiration high risk, no fever, severe anemia, drug food allergy, liver, kidney, cardiopulmonary disease, not taking drugs to influence muscle relaxant, no severe hypertension, heart rate: 60-110 times /min, 3 months before operation to monitor the muscle There were no surgery, trauma or history of puncture. 120 subjects were randomly divided into 4 groups, the control group (group C), rocuronium preinjection group (group R), the combined use of ephedrine group (group E) and the large dose group (group L), 30 cases in each group. All the groups were induced by intravenous injection of amyl hydrochloric acid 0.01 mg/kg, Midda. Zolun 0.05 mg/kg, fentanyl 4 mu g/kg, after the patients' consciousness disappeared to complete the calibration of muscle relaxation monitor, group R, group E were given rocuronium 0.06mg/kg or ephedrine 70 mu g/kg, C group and L group were given 0.9%Na Cl contrast, the four groups were given etomidate 0.3mg/kg at the same time. 0.20mg/kg intravenous injection (Cis.) was used to monitor muscle relaxants by four modes of stimulation (TOF). The anesthesia was maintained by intravenous infusion of remifentanil (0.025~0.4 mu g. Min-1) and propofol (4~12 mg kg-1. H-1), and inhaled seven fluorothane (0.6~1.0). After 1min (T4), 2min (T5), 3min (T6), 4min (T7), 5min (T8), the average arterial pressure (MAP), heart rate (HR) and arterial oxygen saturation (from the end of the muscle relaxant to the count of 0), the duration (from the end of the muscle relaxant to the count of 2), the immediate value of the tracheal intubation, and the evaluation of tracheal intubation The condition was calculated and the excellent rate of tracheal intubation was calculated; the adverse reactions of skin flushing, trachea spasm and arrhythmia during anesthesia were observed. Results: the test was finally included in 104 cases (group C, 27 cases in group E, group R and 25 cases in group L). There was no statistical difference between the groups in sex, age, BMI, and preoperative temperature (P0.05). The different MAP in each group during the induction of anesthesia was different (F=76.116, P=0.000). Compared with other time points, MAP was significantly higher at T3. At T3 point, the MAP significantly increased in E group, and the difference was statistically significant (P=0.033). There was no difference in the trend (F=0.535, P=0.659); the heart rate of each group at different points was different (F=45.319, P=0.000). Compared with other time points, HR increased obviously at T3 and decreased obviously at T2 and T8, and there was no difference between different random groups (F=1.707, P= 0.27). The Sp O2 of each group at different points was different (F=209.549, P=0.000), compared with the other time points, the T1 decreased significantly; the Sp O2 at different points had no difference (F=0.792, P=0.731) in different random groups (F=0.792, P=0.731); Sp O2 in each group had no difference in the variation trend of the same point. Compared with the group, the rest of the other groups increased significantly at the onset time, The difference had statistical significance (P0.05). Compared with group E, the onset time of group R was faster, and the difference was statistically significant (P=0.003). The difference was not statistically significant (P0.05) in group L and E group. In the duration of muscle relaxant, the L group was significantly longer than the other groups, and the difference was statistically significant (P0.05), and there was no difference between the other three groups. Statistical significance (P0.05). Compared with other groups, the TOFr value of tracheal intubation decreased significantly in group R, and the difference was statistically significant (P0.05). Compared with group C and group E, the TOFr value of L group decreased, the difference was statistically significant (P0.05); while the comparison between C, E group was not statistically significant (P0.05). The comparison of the intubation conditions of each group, the difference between the four groups There was no statistical significance (P0.05). There was no adverse reaction during the induction and maintenance of general anesthesia. Conclusion: in the three methods to accelerate the onset time of CIS atracurium, rocuronium preinjection method has the best effect to speed up the onset time. It has excellent intubation conditions, stable induction period and no significant adverse reactions, which can be used in clinical large scale. It is widely used in most patients.

【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

【相似文献】