杜氏肌营养不良症患者中米库氯铵诱导的神经肌肉阻滞的起效时间和持续时间。

Onset and duration of mivacurium-induced neuromuscular block in patients with Duchenne muscular dystrophy.

作者信息

Schmidt J, Muenster T, Wick S, Forst J, Schmitt H J

机构信息

Department of Anaesthesiology, Friedrich-Alexander University, Erlangen-Nuremberg, Krankenhausstrasse 12, D-91054 Erlangen, Germany.

出版信息

Br J Anaesth. 2005 Dec;95(6):769-72. doi: 10.1093/bja/aei249. Epub 2005 Sep 23.

DOI:10.1093/bja/aei249

PMID:16183677

Abstract

BACKGROUND

To determine the response to mivacurium, we prospectively studied onset time and complete spontaneous recovery from mivacurium-induced neuromuscular block in patients with Duchenne muscular dystrophy (DMD).

METHODS

Twelve boys with DMD, age 5-14 yr, seven of them wheelchair-bound, ASA II-III, and 12 age- and sex-matched controls (ASA I) were enrolled in the study. Anaesthesia was induced with fentanyl 2-3 microg kg(-1) and propofol 3-4 mg kg(-1) titrated to effect, and maintained by continuous i.v. infusion of propofol 8-12 mg kg(-1) and remifentanil as required. The lungs were ventilated with oxygen in air. Neuromuscular transmission was assessed by acceleromyography using train-of-four (TOF) stimulation every 15 s. After baseline readings, a single dose of mivacurium 0.2 mg kg(-1) was given. The following variables were recorded: (i) lag time; (ii) onset time; (iii) peak effect; (iv) recovery of first twitch from the TOF response to 10, 25 and 90% (T(10), T(25), T(90)) relative to baseline; (v) recovery index (time between 25 and 75% recovery of first twitch); and (vi) recovery time (time between 25% recovery of first twitch and recovery of TOF ratio to 90%). For comparison between the groups the Mann-Whitney U-test was applied.

RESULTS

There were no differences between the groups in lag time, onset time and peak effect. However, all recorded recovery indices were significantly (P<0.05) prolonged in the DMD group. The median (range) for time points T(10), T(25) and T(90) in the DMD and control group was 12.0 (8-16) vs 8.4 (5-15) min, 14.1 (9-20) vs 10.5 (7-17) min and 26.9 (15-40) vs 15.9 (12-23) min, respectively. The recovery index and recovery time were similarly prolonged in the DMD group.

CONCLUSIONS

These results support the assumption that mivacurium-induced neuromuscular block is prolonged in patients with DMD.

摘要

背景

为了确定对米库氯铵的反应，我们前瞻性地研究了杜氏肌营养不良症（DMD）患者米库氯铵诱导的神经肌肉阻滞的起效时间和完全自发恢复情况。

方法

12名年龄在5至14岁的DMD男孩，其中7名需借助轮椅行动，ASA分级为II - III级，以及12名年龄和性别匹配的对照组（ASA I级）纳入本研究。用2 - 3μg/kg的芬太尼和3 - 4mg/kg的丙泊酚诱导麻醉，根据效果进行滴定，并用8 - 12mg/kg的丙泊酚持续静脉输注并按需给予瑞芬太尼维持麻醉。用空气和氧气混合通气。每隔15秒通过四个成串刺激（TOF）的加速度肌电图评估神经肌肉传递。在基线读数后，给予单剂量0.2mg/kg的米库氯铵。记录以下变量：（i）滞后时间；（ii）起效时间；（iii）最大效应；（iv）TOF反应中第一个肌颤搐相对于基线恢复到10%、25%和90%（T(10)、T(25)、T(90)）的时间；（v）恢复指数（第一个肌颤搐从25%恢复到75%的时间）；以及（vi）恢复时间（第一个肌颤搐从25%恢复到TOF比值恢复到90%的时间）。两组间比较采用Mann - Whitney U检验。

结果

两组在滞后时间、起效时间和最大效应方面无差异。然而，DMD组所有记录的恢复指标均显著延长（P<0.05）。DMD组和对照组T(10)、T(25)和T(90)时间点的中位数（范围）分别为12.0（8 - 16）分钟对8.4（5 - 15）分钟、14.1（9 - 20）分钟对10.5（7 - 17）分钟和26.9（15 - 40）分钟对15.9（12 - 23）分钟。DMD组的恢复指数和恢复时间同样延长。