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两种新型肌肉松弛剂(阿曲库铵和维库溴铵)在成人中的临床应用

[Clinical use in adults of 2 new muscle relaxants: atracurium and vecuronium].

作者信息

Michel H, Briot D, Perrot G, Muller A, Barth P, Gauthier-Lafaye P

出版信息

Ann Fr Anesth Reanim. 1984;3(4):277-83. doi: 10.1016/s0750-7658(84)80120-3.

Abstract

115 general and urologic surgery adult patients, ASA class I-II, were divided in four groups according to initial bolus and relaxant used: group A atracurium 0.6 mg X kg-1, group B 0.5 mg X kg-1, group C vecuronium 0.1 mg X kg-1 and group D pancuronium 0.1 mg X kg-1. When the single twitch recovered to 25% of control height (T25), subgroups were individualized depending on whether repeat doses of 1/3 of initial bolus were given or not, and whether reversal was spontaneous or obtained by a standard dose of neostigmine 2.5 mg and atropine 1.25 mg. By ulnar nerve stimulation at the wrist, the force of thumb adduction was recorded on a polygraph; single twitch (tw), train of four (tof) and ratio tof 4/1 (Rtof) were measured. Anaesthesia was induced with thiopentone and fentanyl without premedication and maintained with fentanyl and N2O in oxygen; the trachea was intubated once the block was at its maximum. The onset time of maximal block was 5 min for groups A, B and C, and 7.9 min for group D. T25 was 39.9 +/- 8.5 min for group A, 34.4 +/- 9.7 min for group B, 28.9 +/- 9.9 min for group C and 70.7 +/- 25.9 min for group D. A Rtof equal to 75% was achieved in less than 65 min with atracurium and vecuronium, but much later with pancuronium. Reversal at T25 was efficient, but not really required, for atracurium and vecuronium, but necessary and useful for pancuronium.(ABSTRACT TRUNCATED AT 250 WORDS)

摘要

115例美国麻醉医师协会(ASA)分级为I-II级的普通外科和泌尿外科成年患者,根据初始推注剂量和使用的肌松剂分为四组:A组使用阿曲库铵0.6mg/kg,B组使用0.5mg/kg,C组使用维库溴铵0.1mg/kg,D组使用泮库溴铵0.1mg/kg。当单刺激恢复到对照高度的25%(T25)时,根据是否给予初始推注剂量的1/3重复剂量以及恢复是自发的还是通过标准剂量的新斯的明2.5mg和阿托品1.25mg实现,将亚组个体化。通过腕部尺神经刺激,在多导生理记录仪上记录拇指内收力;测量单刺激(tw)、四个成串刺激(tof)和tof 4/1比值(Rtof)。麻醉诱导采用硫喷妥钠和芬太尼,无术前用药,维持采用芬太尼和氧气中的N2O;一旦肌松达到最大程度即行气管插管。A、B、C组最大肌松的起效时间为5分钟,D组为7.9分钟。A组T25为39.9±8.5分钟,B组为34.4±9.7分钟,C组为28.9±9.9分钟,D组为70.7±25.9分钟。使用阿曲库铵和维库溴铵时,Rtof等于75%在不到65分钟内实现,但使用泮库溴铵时则要晚得多。T25时的恢复对于阿曲库铵和维库溴铵有效,但并非真正必需,而对于泮库溴铵则是必要且有用的。(摘要截断于250字)

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