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体温对老年人顺式阿曲库铵与罗库溴铵恢复时相影响的比较
A comparison of the effect of body temperature on the relaxation recovery of cisatracurium and rocuronium in elder patients.

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DOI:
作者:
吴敏仙 李士通
WU Min-xian ,LI Shi-tong
作者单位:
上海交通大学医学院附属第一人民医院研究生 上海市曙光医院宝山分院 上海交通大学医学院附属第一人民医院
The First People’s Hospital Affiliated to Shanghai Jiaotong University
关键词:
顺式阿曲库铵；罗库溴铵；老年病人；体温；肌松恢复
Cisatracurium; Rocuronium; Elder patient; Body temperature; Relaxants recovery
摘要:
目的：比较不同体温对老年病人术后顺式阿曲库铵和罗库溴铵肌松恢复的影响。方法：择期全麻手术老年患者80例，随机分为4组，分别为A、B、C、D组，每组20例，A、B组给予顺式阿曲库铵，C、D组给予罗库溴铵， A、C组为非保温组，术中不采取特殊保温措施，B、D组为保温组，用保温毯进行保温。采用全身麻醉联合硬膜外麻醉，全麻诱导插管用顺式阿曲库铵0.15 mg／kg或罗库溴铵0.6 mg／kg，术中肌松药静脉泵注维持，持续监测肌松和鼻咽温度，记录起效时间、累积剂量、手术时间、T1恢复至25％ 、50％ 、75％ 、TOFR恢复至90％的时间以及麻醉诱导时、T1恢复至25％时、TOFR恢复至90%时的温度。结果：术毕非保温组病人（A与C组）体温明显下降，与保温组病人（B与D组）比较差异显著(P<0.01)。顺式阿曲库铵组的起效时间长于罗库溴铵组(P<0.01)，而肌松恢复指数（ T1自25%恢复至75%的时间）明显短于罗库溴铵组(P<0.01)，保温组完全恢复时间（T1自25%到TOFR恢复至90%的时间）也短于罗库溴铵组(P<0.01) 。同一肌松药保温组病人起效时间没有明显差异，而肌松恢复指数和完全恢复时间均短于非保温组(P<0.05)，顺式阿曲库铵组更加明显(P<0.01)。结论：老年病人容易发生术中低体温，保温有助于肌松的恢复，特别是顺式阿曲库铵。
Objective：To investigate the effect of body temperature on the relaxation recovery of cisatracurium and rocuronium in elder patients. Methods： Eighty elder patients undergoing elective surgery were randomly divided into one of the following groups: muscle relaxation was maintained with cisatracurium in Group A and B; and with rocuronium in groups C and D respectively. Body temperature was preserved with a heat-protecting blanket in Group B and D .Group A and Group C were set as control. All patients received general anaesthesia combined with epidural anaesthesia. Intubation was conducted with cisatracurium 0.15 mg／kg or rocuronium 0.6 mg／kg according to the grouping. Muscle relaxants were infused by a pump during the operation. The parameters of temperature and muscle relaxation were recorded during the whole procedure, including: the onset time and total dosage of the relaxant; duration of the operation, durations of T1 recovery to 25%、 50%、 75%; durations of TOFR recovery to 25% 、50% 、75%; the nasopharyngeal temperatures at induction, 25% T1 recovery,90% TOFR recovery . Results：In control groups (Group A and C), patients had a significant lower temperature as compared with the others (Group B and D) （P<0.01）. The onset time of cisatracurium were longer than that of rocuronium ,while the recovery index (T1 25% to 75%) of cisatracurium was much less than that of rocuronium （P<0.01）. In heat preserving groups the total recovery time ( T1 25% to TOFR 90%) of cisatracurium was also less than that of rocuronium（P<0.01）. There were no significant differences with respect to the onset time of the same muscle relaxants ,while the recovery index and total recovery time of the heat preserving groups were shorter than those of the non-heat preserving groups（P<0.05）,especially in cisatracurium groups（P<0.01）. Conclusion：Elder patients tended to occur hypothermia in the operation. Heat protection was helped to the recovery of relaxants, especially with cisatracurium.

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