Sladen R N, Berend J Z, Fassero J S, Zehnder E B
Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
J Cardiothorac Vasc Anesth. 1995 Apr;9(2):147-53. doi: 10.1016/S1053-0770(05)80185-5.
The use of vecuronium and meperidine on the clinical and metabolic effects of shivering in mechanically ventilated patients after hypothermic cardiopulmonary bypass (CPB) was compared. Twenty adult male patients undergoing cardiac surgery were randomized to meperidine, 25 to 75 mg (n = 10), or vecuronium, 0.1 microgram/kg (n = 10), for the treatment of shivering during postoperative rewarming. Vecuronium was continued as an infusion at 1.0 microgram/kg/min for 4 hours. Meperidine abolished shivering in 50% of patients with a 60% recurrence within 2 hours and did not correct acute respiratory acidosis when it occurred. Vecuronium uniformly abolished shivering, corrected acute respiratory acidosis, and improved mixed venous oxygen saturation (20% v 4%), decreased oxygen consumption (-32% v -7%) and decreased end-tidal carbon dioxide (-21% v -5%) significantly more than meperidine (p < 0.005). Meperidine administration caused a significant decline in systolic blood pressure (121.9 +/- 10.6 mmHg to 106.9 +/- 8.5 mmHg, p = < 0.02). The authors conclude that, during rewarming after hypothermic CPB, muscle relaxation with vecuronium reverses both the clinical and metabolic effects of shivering more reliably and effectively than repeated boluses of meperidine, and with greater hemodynamic stability. Control can be maintained by continuous infusion of vecuronium with concomitant sedation for up to 4 hours without prolonging intubation time.
比较了维库溴铵和哌替啶对低温体外循环（CPB）后机械通气患者寒战的临床和代谢影响。20例接受心脏手术的成年男性患者被随机分为两组，一组接受25至75毫克哌替啶治疗（n = 10），另一组接受0.1微克/千克维库溴铵治疗（n = 10），用于术后复温期间寒战的治疗。维库溴铵以1.0微克/千克/分钟的速度持续输注4小时。哌替啶使50%的患者寒战消失，但2小时内复发率为60%，且发生急性呼吸性酸中毒时无法纠正。维库溴铵能完全消除寒战，纠正急性呼吸性酸中毒，显著改善混合静脉血氧饱和度（分别为20%对4%）、降低氧耗量（-32%对-7%）以及降低呼气末二氧化碳（-21%对-5%），效果明显优于哌替啶（p < 0.005）。使用哌替啶导致收缩压显著下降（从121.9±10.6毫米汞柱降至106.9±8.5毫米汞柱，p = < 0.02）。作者得出结论，在低温CPB后的复温过程中，与反复推注哌替啶相比，维库溴铵引起的肌肉松弛能更可靠、有效地逆转寒战的临床和代谢影响，且血流动力学稳定性更好。通过持续输注维库溴铵并同时给予镇静，可维持控制长达4小时，而不会延长插管时间。
