氯化镁对罗库溴铵诱导的神经肌肉阻滞及琥珀酸舒更葡糖钠逆转作用的影响：一项在离体外分离的大鼠膈神经-膈肌制备物中的研究。

Effects of magnesium chloride on rocuronium-induced neuromuscular blockade and sugammadex reversal in an isolated rat phrenic nerve-hemidiaphragm preparation: An in-vitro study.

机构信息

From the Konyang University Hospital, Konyang University College of Medicine, Daejeon (T-YS, H-JY, C-KC), Inje University Seoul Paik Hospital, Seoul (HRC), Gachon University Gil Medical Center, Incheon (YBK), Chungnam National University School of Medicine, Daejeon (YSS) and Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (HSY).

出版信息

Eur J Anaesthesiol. 2018 Mar;35(3):193-199. doi: 10.1097/EJA.0000000000000714.

DOI:10.1097/EJA.0000000000000714

PMID:28937530

Abstract

BACKGROUND

Magnesium potentiates the effects of nondepolarising muscle relaxants. However, few studies have used magnesium chloride (MgCl2). Sugammadex reverses neuromuscular block by steroidal nondepolarising muscle relaxants.

OBJECTIVES

To assess the effects of MgCl2 on rocuronium-induced neuromuscular blockade and its reversal by sugammadex.

DESIGN

In-vitro experimental study.

SETTING

Animal laboratory, Asan Medical Center, Seoul, South Korea, from 20 March 2016 to 3 April 2016.

ANIMALS

Forty male Sprague Dawley rats.

INTERVENTION

Left phrenic nerve-hemidiaphragms from 40 Sprague Dawley rats were allocated randomly to four groups (1, 2, 3 and 4 mmol l MgCl2 group, n = 10 each). Rocuronium was administered cumulatively until the first twitch of train-of-four (TOF) disappeared completely. Then, equimolar sugammadex was administered.

MAIN OUTCOME MEASURES

The effective concentration (EC) of rocuronium was obtained in each group. After administering sugammadex, recovery of the first twitch height and the TOF ratio were measured for 30 min.

RESULTS

EC50, EC90 and EC95 significantly decreased as the concentration of MgCl2 increased (all P ≤ 0.001), except the comparison between the 3 and 4 mmol l MgCl2 groups. After administration of sugammadex, the maximal TOF ratio (%) was lower in the 4 mmol l MgCl2 group than the 1 mmol l MgCl2 group [median 91.7 interquartile range (83.4 to 95.8) vs. 98.3 interquartile range (92.2 to 103.4), P = 0.049]. The mean time (s) from sugammadex injection to achieving maximal first twitch was significantly prolonged in the 4 mmol l MgCl2 group vs. the 1 mmol l MgCl2 and 2 mmol l MgCl2 groups [1483.9 (± 237.0) vs. 1039.0 (± 351.8) and 926.0 (± 278.1), P = 0.022 and 0.002, respectively].

CONCLUSION

Increases in MgCl2 concentration reduce the ECs of rocuronium. In addition, administering sugammadex equimolar to the administered rocuronium shows limited efficacy as MgCl2 concentration is increased.

TRIAL REGISTRATION

The in-vitro study was not registered in a database.

摘要

背景

镁可增强非去极化肌松药的作用。然而，很少有研究使用氯化镁（MgCl2）。向镁盐中加入顺式阿曲库铵可逆转去极化肌松药引起的神经肌肉阻滞。

目的

评估氯化镁对罗库溴铵诱导的神经肌肉阻滞的影响及其对顺式阿曲库铵的逆转作用。

设计

体外实验研究。

地点

动物实验室，韩国首尔峨山医疗中心，2016 年 3 月 20 日至 4 月 3 日。

动物

40 只雄性 Sprague Dawley 大鼠。

干预

将 40 只 Sprague Dawley 大鼠的左侧膈神经-半膈肌随机分配到四组（1、2、3 和 4 mmol l MgCl2 组，每组 10 只）。罗库溴铵累积给药，直至四串刺激（TOF）的首串完全消失。然后，给予等摩尔量的顺式阿曲库铵。

主要观察指标

各组获得罗库溴铵的有效浓度（EC）。给予顺式阿曲库铵后，测量 30 分钟内首搐高度和 TOF 比值的恢复情况。

结果

随着 MgCl2 浓度的增加，EC50、EC90 和 EC95 显著降低（均 P≤0.001），但 3 和 4 mmol l MgCl2 组之间的比较除外。给予顺式阿曲库铵后，4 mmol l MgCl2 组的最大 TOF 比值（%）明显低于 1 mmol l MgCl2 组[中位数 91.7 四分位距（83.4 至 95.8）比 98.3 四分位距（92.2 至 103.4），P=0.049]。4 mmol l MgCl2 组从顺式阿曲库铵注射到达到最大首搐的平均时间（s）明显长于 1 mmol l MgCl2 组和 2 mmol l MgCl2 组[1483.9（±237.0）比 1039.0（±351.8）和 926.0（±278.1），P=0.022 和 0.002]。