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拔管前给予艾司洛尔对维库溴铵肌松恢复和拮抗效果的影响
Effects of using esmolol before extubation on recovery from vecuronium-induced neuromusuclar blockade and the antagonism of neostigmine
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DOI:
作者:
毛祖旻,李士通,黄施伟
MAO Zumin,LI Shitong,HUANG Shiwei
作者单位:
上海交通大学附属第一人民医院麻醉科
Department of Anesthesiology,Shanghai First People’s Hospital
关键词:
艾司洛尔;维库溴铵;肌松恢复,肌松拮抗
Esmolol;Vecuronium;Neuromuscular blockade recover;Neuromuscular blockade,antagonism
摘要:
目的 观察全身麻醉结束时气管导管拔除前给予艾司洛尔抑制心血管反应对维库溴铵残余肌松恢复和拮抗效果的影响。方法 选择择期于全身麻醉下行妇科手术的患者92例,美国麻醉医师学会(ASA)分级为Ⅰ~Ⅱ级,随机分成4组。Ⅰ组为术后肌松自然恢复,拔管前给予艾司洛尔组;Ⅱ组为术后肌松自然恢复,拔管前给予生理盐水组;Ⅲ组为新斯的明拮抗肌松,拔管前给予艾司洛尔组;Ⅳ组为新斯的明拮抗肌松,拔管前给予生理盐水组。予芬太尼、丙泊酚、维库溴铵0.10mg/kg行全身麻醉诱导气管插管,术中间断追加维库溴铵0.03mg/kg。术毕当TOF模式肌松监测的第四个肌颤搐(T4)出现时给予Ⅲ、Ⅳ组新斯的明0.04 mg/kg和阿托品0.02 mg/kg,达临床拔管指征后,给予Ⅰ组和Ⅲ组艾司洛尔1mg/kg(稀释至10ml)、Ⅱ组和Ⅳ组生理盐水10ml,1min后拔管。记录四组患者拔管即刻的TOF值及拔管即刻到TOF值恢复到0.9的时间,记录患者基线水平(t0)、拔管前1min(t1)、拔管即刻(t2)、拔管后2min(t3)、拔管后5min(t4)、拔管后10min(t5)的心率和血压。结果 4组间年龄、体质指数、维库溴铵用量、麻醉持续时间、术毕体温的差异均无统计学意义(P值均>0.05)。Ⅰ、Ⅲ组拔管即刻及拔管后的2min的心率、收缩压、舒张压均显著低于Ⅱ、Ⅳ组(P<0.05),Ⅰ组拔管后的5min、10min的心率显著低于Ⅱ组(P<0.05),Ⅲ组拔管后5min的心率显著低于Ⅳ组(P<0.05)。4组拔管即刻到TOF值恢复到0.9的时间分别为(24.49±5.40)、(23.12±4.43)、(14.43±3.59)、(12.65±3.22)min,Ⅰ、Ⅱ组间及Ⅲ、Ⅳ组间拔管即刻到TOF值恢复到0.9的时间无统计学差异(P>0.05)。结论 拔管前给予艾司洛尔可有效抑制拔管时的心血管反应,对维库溴铵残余肌松的恢复和拮抗效果无影响。
Objective To investigate the effects of using esmolol before endotracheal extubation on the recovery from vecuronium-induced neuromusuclar blockade and the antagonistic effect of neostigmine. Methods Ninety-two patients of American Society of Anesthesioiogists (ASA) physical stateⅠ-Ⅱ undergoing elective gynecology surgeries under general anesthesia were randomly divided into four groups(n=23 each):group Ⅰ using esmolol before extubation and allowing spontaneous recovery of vecuronium-induced neuromuscular blockade;group Ⅱ using normal saline before extubation and allowing spontaneous recovery;group Ⅲ using esmolol before extubation and the residual neuromuscular blockade was antagonized with neostigmine;group Ⅳ using normal saline before extubation and the residual neuromuscular blockade was antagonized with neostigmine. Patients were induced and intubated with fentanyl,propofol and vecuronium (0.1mg/kg) in all the four groups. Bolus of vecuronium (0.03mg/kg) was injected when required during surgery. Neostigmine (0.04mg/kg) and atropine (0.02mg/kg) were administrated when T4 appeared postoperatively in group Ⅲ and group Ⅳ. When the cilinical indication of extubation was reached,esmolol (1mg/kg, diluted to 10ml) was administrated 1min before the extubation in group Ⅰ and group Ⅲ,10ml normal saline was administrated 1min before the extubation in group Ⅱ and group Ⅳ. The train-of-four ratio (TOFR) at the moment of extubation,the interval of TOFR recovery from the moment of extubation to 0.9,the heart rate and blood pressure at the time of the baseline (t0),1min before the extubation (t1),at extubation (t2),2min after the extubation (t3),5min after the extubation (t4),10min after the extubation(t5) were observed and documented. Results There were no significant differences among four groups with respect to age,body mass index,total consumption of vecuronium,anesthesia duration or the body temperature after the operation. The heart rate , systolic blood pressure and diastolic pressure were significantly lower in group Ⅰ and group Ⅲ than those in group Ⅱ and group Ⅳ at the time of t2 and t3 (P<0.05),also the heart rate were significantly lower in group Ⅰ than that in group Ⅱ at the time of t4 and t5 (P<0.05),the heart rate was significantly lower in group Ⅲ than that in group Ⅳ at the time of t4 (P<0.05). The interval of TOFR recovery from the moment of extubation to 0.9 in group Ⅰ,Ⅱ,Ⅲ and group Ⅳ were (24.49±5.40)、(23.12±4.43)、(14.43±3.59)、(12.65±3.22)min,respectively. There was no significant difference in the interval of TOFR recovery from the moment of extubation to 0.9 between group Ⅰ and group Ⅱ,or between group Ⅱ and group Ⅳ(P>0.05). Conclusions Esmolol (1mg/kg) could attenuate cardiovascular responses to extubation efficiently,and didn't prolong the spontaneous recovery of neuromuscular blockade induced by vecuronium and the recovery after antagonizing with neostigmine.
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