Nigrovic V, Banoub M
Department of Anesthesiology, Medical College of Ohio, Toledo 43699-0008.
Anesth Analg. 1993 Jan;76(1):85-91. doi: 10.1213/00000539-199301000-00015.
The purpose of our study was a unified description of the time course for the onset of the neuromuscular block produced by different muscle relaxants after bolus intravenous injections. The environment of the receptors on the motor end plate was assumed to be a part of the interstitial space of the muscle. A unified consideration of four muscle relaxants was accomplished by expressing the concentrations of each relaxant in the interstitial space as multiples of the relaxant's dissociation constant. A flow-limited model was developed to describe the time course of the relaxant's concentration in the interstitial space as a function of its plasma concentration, the plasma flow to the muscle, and the volume of the interstitial space. The results show that those relaxants whose plasma concentrations decrease rapidly achieve an earlier (4-8 min), but relatively lower, peak concentration in the interstitial space. The relaxants with more sustained plasma concentrations reach the peak concentration later, 9-16 min after the bolus intravenous injection. The model allows the interpretation of several observations encountered with the clinical use of the muscle relaxants.
我们研究的目的是对静脉注射大剂量不同肌肉松弛剂后神经肌肉阻滞起效的时间进程进行统一描述。运动终板上受体所处的环境被认为是肌肉间质空间的一部分。通过将间质空间中每种松弛剂的浓度表示为该松弛剂解离常数的倍数，实现了对四种肌肉松弛剂的统一考量。建立了一个流量限制模型，以描述间质空间中松弛剂浓度随血浆浓度、流向肌肉的血浆流量以及间质空间体积变化的时间进程。结果表明，血浆浓度迅速下降的那些松弛剂在间质空间中达到峰值浓度的时间较早（4 - 8分钟），但峰值浓度相对较低。血浆浓度维持时间较长的松弛剂在静脉注射大剂量后较晚（9 - 16分钟）达到峰值浓度。该模型有助于解释在临床使用肌肉松弛剂时遇到的一些观察结果。
