Lagneau Franck, D'honneur Gilles, Plaud Benoît, Mantz Jean, Gillart Thierry, Duvaldestin Philippe, Marty Jean, Clyti Nathalie, Pourriat Jean-Louis
Department of Anesthesia and Intensive Care Unit, Beaujon Hospital, Université Paris VII, 100 boulevard du Général Leclerc, 92 118 Clichy Cedex, France.
Intensive Care Med. 2002 Dec;28(12):1735-41. doi: 10.1007/s00134-002-1508-y. Epub 2002 Oct 29.
To compare two levels of continuous cisatracurium-induced curarization in hypoxemic, ventilated patients.
An open-labeled, multicenter, prospective, randomized study.
Hundred two patients with a ratio between arterial oxygen tension and inspired oxygen tension (PaO(2)/FIO(2)) less than 200 despite optimization of sedation and ventilation were randomized into group 1 (n=52) with an end point of no response at orbicularis oculi to train-of-four (TOF) stimulation or group 2 (n=50) with an end point of two responses.
The PaO(2)/FIO(2) and end-inspiratory plateau airway pressure (Pplat) were evaluated at baseline (before curarization) and at regular intervals once TOF end points had been attained for up to 2 h afterwards (T2 h). A decrease of 1 cmH(2)O or more of Pplat at T2 h compared to baseline was observed in 37% and 50% of the patients in groups 1 and 2, respectively (p=0.17). Time courses of PaO(2)/FIO(2) (mmHg) and Pplat (cmH(2)O) [mean (SD)] were equivalent in both groups, with a mild increase in PaO(2)/FIO(2) [p=0.0014; from 126 (33) to 141 (55) and from 134 (40) to 152 (52), respectively, in groups 1 and 2] and decrease in Pplat [p=0.016; from 29.1 (8.9) to 28.5 (8.8) and from 27.7 (7.5) to 26.6 (7.6)]. Median total durations of curarization were 28.9 h (3.1-219.7) in group 1 and 31.4 h (1.6-650.6) in group 2. Median cisatracurium infusion rates were 5.2 microg kg(-1) min(-1) (2.1-13.7) in group 1 and 3.6 microg kg(1) min(-1) (1.0-13.5) in group 2. The median delay to recovery from paralysis was shorter in group 2 (0.75 h vs 1.25 h; p=0.0008).
When a prolonged curarization is decided upon in an ICU patient, a blockade at 2/4 at TOF at orbicularis oculi has similar effects on respiratory parameters as a blockade at 0/4, allowing a decrease in total administered doses and a shortening of the recovery of muscle strength after cessation of infusion.
比较低氧血症通气患者中两种顺式阿曲库铵持续诱导肌松水平。
一项开放标签、多中心、前瞻性、随机研究。
尽管已优化镇静和通气，但动脉血氧分压与吸入氧分压之比（PaO₂/FIO₂）小于200的102例患者被随机分为两组，第1组（n = 52）以眼轮匝肌对四个成串刺激（TOF）无反应为终点，第2组（n = 50）以两个反应为终点。
在基线（肌松前）以及达到TOF终点后每2小时（T2 h）定期评估PaO₂/FIO₂和吸气末平台气道压（Pplat）。与基线相比，T2 h时Pplat下降1 cmH₂O或更多的情况在第1组和第2组患者中分别为37%和50%（p = 0.17）。两组中PaO₂/FIO₂（mmHg）和Pplat（cmH₂O）[均值（标准差）]的时间进程相当，PaO₂/FIO₂有轻度升高[第1组和第2组分别为p = 0.0014；从126（33）升至141（55）以及从134（40）升至152（52）]，Pplat下降[p = 0.016；从29.1（8.9）降至28.5（8.8）以及从27.7（7.5）降至26.6（7.6）]。第1组肌松的总持续时间中位数为28.9小时（3.1 - 219.7），第2组为31.4小时（1.6 - 650.6）。第1组顺式阿曲库铵的输注速率中位数为5.2μg·kg⁻¹·min⁻¹（2.1 - 13.7），第2组为3.6μg·kg⁻¹·min⁻¹（1.0 - 13.5）。第2组从麻痹恢复的延迟中位数较短（0.75小时对1.25小时；p = 0.0008）。
当决定对ICU患者进行长时间肌松时，眼轮匝肌TOF比值为2/4的阻滞对呼吸参数的影响与0/4阻滞相似，可减少总给药剂量并缩短输注停止后肌肉力量的恢复时间。
