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七例剖宫产患者罗库溴铵诱导的神经肌肉阻滞用苏伽 939 逆转的研究

Sugammadex reversal of rocuronium-induced neuromuscular block in Caesarean section patients: a series of seven cases.

机构信息

Department of Anaesthesiology and Intensive Care Medicine, Klinikum am Steinenberg,Steinenbergstrasse 31, D-72764 Reutlingen, Germany.

出版信息

Br J Anaesth. 2010 Nov;105(5):657-60. doi: 10.1093/bja/aeq227. Epub 2010 Aug 24.

Abstract

Sugammadex is a selective relaxant-binding agent, which reverses rocuronium-induced neuromuscular blocks of any depth by chemical encapsulation of rocuronium in the plasma in various groups of patients. We reported seven Caesarean section cases, undergoing general anaesthesia with thiopental (6 mg kg⁻¹) and rocuronium (0.6 mg kg⁻¹) who were given desflurane and fentanyl for maintenance of anaesthesia after delivery. The action of rocuronium may be prolonged in pregnant women. At the end of the operation, all patients had a significant degree of neuromuscular block. In five patients, there was no single twitch response and no TOF ratio, one patient had one twitch detectable, and in one patient, a TOF ratio of 3% was detected. The recommended dose of sugammadex for reversal of profound block (4 mg kg⁻¹) or moderate block (2 mg kg⁻¹) was given. In all patients, sugammadex provided rapid and sufficient reversal to TOF >0.9 within 2 min. All patients were monitored after operation, and no signs of recurarization occurred in any patient and no signs of neuromuscular weakness were observed.

摘要

罗库溴铵诱导的神经肌肉阻滞作用可被苏伽 (氨甲酰) 六甲溴铵所拮抗,无论患者的分组情况如何,该药物都能通过在血浆中化学包裹罗库溴铵来逆转罗库溴铵引起的不同深度的神经肌肉阻滞作用。本研究报告了 7 例剖宫产全麻患者的临床资料,麻醉诱导采用硫喷妥钠(6mg/kg)和罗库溴铵(0.6mg/kg),在胎儿娩出后给予地氟烷和芬太尼维持麻醉。孕妇体内的罗库溴铵作用时间可能延长。手术结束时,所有患者都有明显程度的神经肌肉阻滞。在 5 例患者中,无一例出现单颤搐反应和四成肌松监测(TOF)比值,1 例患者可检测到 1 个颤搐,1 例患者的 TOF 比值为 3%。推荐使用苏伽(氨甲酰)六甲溴铵逆转深度阻滞(4mg/kg)或中度阻滞(2mg/kg)。在所有患者中,苏伽(氨甲酰)六甲溴铵在 2 分钟内迅速充分逆转 TOF>0.9。所有患者术后均进行监测,未发现任何患者出现再去极化迹象,也未观察到神经肌肉无力迹象。

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