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瑞芬太尼对琥珀胆碱引起的肌纤维成束收缩和肌痛的影响
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DOI:
作者:
徐文庆
xu wenqing
作者单位:
上海市金山区亭林医院
Tinglin Hospital,Shanghai
关键词:
琥珀胆碱;瑞芬太尼;肌纤维成束收缩;术后肌痛
Succinylcholine; Remifentanil; Muscle fasciculation; Postoperative myalgia
摘要:
【摘要】 目的 观察瑞芬太尼对琥珀胆碱引起的肌纤维成束收缩和肌痛的影响。方法 选择100例择期采用静吸复合麻醉支撑喉镜下声带显微手术患者,年龄25~65岁,美国麻醉医师学会分级Ⅰ或Ⅱ级,随机分入瑞芬组和对照组,每组50例。两组患者均静脉注射芬太尼2μg/kg、异丙酚2 mg/kg和琥珀胆碱1.5 mg/kg行麻醉诱导,瑞芬组在诱导前5 min经静脉输注泵注射瑞芬太尼0.2 µg.kg-1.min-1,气管插管后两组均吸入七氟烷维持麻醉,静脉间断注射琥珀胆碱0.2mg/kg,瑞芬组术中维持静脉注射瑞芬太尼0.1~0.2 µg.kg-1.min-1。观察注射琥珀胆碱后的肌纤维成束收缩程度,记录琥珀胆碱的用量。术后24 h随访患者的肌痛发生情况。结果 瑞芬组的肌纤维成束收缩发生率为98%(49/50),对照组为96%(48/50),两组间的差异无统计学意义(P>0.05),严重程度两组间的差异无统计学意义(P>0.05);患者的肌纤维成束收缩与术后肌痛无关联(P>0.05);瑞芬组的术后肌痛发生率(42%)有低于对照组(52%)的趋势,但两组间的差异无统计学意义(P>0.05);瑞芬组的琥珀胆碱用量显著低于对照组(P<0.01)。结论 瑞芬太尼并不能减轻琥珀胆碱所引起的肌纤维成束收缩发生率和严重程度,术后肌痛发生率和严重程度无显著影响,瑞芬太尼能减少琥珀胆碱的用量。
【Abstract】Objective To observe the effect of remifentanil on succinylcholine-induced muscle fasciculation and myalgia. Methods One hundred patients scheduled for the vocal cord surgery through suspension laryngoscopy were divided into remifentanil-group and control-group randomly (n=50). The age of the patients ranged from 25 to 65 years and the assessment of American Society of Anesthesiologists (ASA) was Ⅰor Ⅱ. Anesthesia induction was conducted with fentanyl 2 μg/kg, propofol 2 mg/kg and succinylcholine 1.5 mg/kg. Succinylcholine was administered 1 minute before endotracheal intubation. The anesthesia was maintained with sevoflurane and succinylcholine. Patients in the remifentanil-group were pretreated with remifentanil 0.2 µg.kg-1.min-1, maintained with remifentanil 0.1~0.2 µg.kg-1.min-1. The fasciculations were observed. The consumption of succinylcholine was recorded. Myalgia was assessed at 24 hours postoperatively. Results The incidence of muscle fasciculation was similar in two groups (98% vs.96%, P > 0.05 ), so was the severity of fasciculations (P > 0.05). Postoperative myalgia was similar in two groups too (P > 0.05). The fasciculation was not related to postoperative myalgia (P > 0.05). The consumption of succinylcholine in the remifentanil-group was significantly lower than in the control-group (P<0.01). Conclusion Remifentanil did not reduces the incidence and severity of fasciculations. Remifentanil did not have any effect on the incidence and severity of postoperative myalgia. Remifentanil can reduce the consumption of succinylcholine.
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