Scholz J, von Knobelsdorff G, Peters K, Kycia B, Schulte am Esch J
Abteilung für Anästhesiologie des Universitäts-Krankennauses Eppendorf, Hamburg.
Anaesthesiol Reanim. 1997;22(4):95-9.
This study investigates the effects of mivacurium (3 times ED95) on neuromuscular block, intubation conditions and general safety in comparison with equipotent doses of atracurium and vecuronium. Following Ethical Care Committee approval and informed consent, 90 ASA I+II patients aged 18 to 65 were studied undergoing elective ENT surgery. Anaesthesia was induced with 1.5 mg/kg propofol and 0.2 mg/kg alfentanil and maintained through continuous infusion of propofol (8 to 10 mg . kg-1 . h-1) and nitrous oxide in oxygen. After achieving stable anaesthesia, the patients received bolus injections of mivacurium (0.20 mg/kg, n = 30), atracurium (0.69 mg/kg, n = 30) or vecuronium (0.14 mg/kg, n = 30) for endotracheal intubation. Intubation was attempted 120 s after drug application and the intubation conditions were assessed. Relaxation was recorded using peripheral nerve stimulation (Train of four). During the observation period, signs of histamine release, respiratory difficulty, cardiovascular events or other adverse signs were monitored. Onset of relaxation was longer for mivacurium (2.3 +/- 1.3 min) compared with atracurium (1.4 +/- 0.7 min) or vecuronium (1.3 +/- 0.3 min). Intubation conditions 120 s after drug application were good or very good in only 67% of cases given mivacurium compared with 90% given atracurium and 100% given vecuronium. The recovery time (DUR 25) was shorter in the mivacurium group (19.5 +/- 7.9 min) compared with atracurium (54.7 +/- 6.6 min) and vecuronium (44.3 +/- 8.6 min). Heart rate and blood pressure were similar in all groups. Facial flushing and mild bronchospasms as signs of histamine release resulted more often in the mivacurium (20%) and atracurium groups (23%) than in the vecuronium group (3%). In contrast to atracurium and vecuronium, recovery from mivacurium-induced neuromuscular blockade is rapid. However, the onset time after 3 times ED95 was significantly longer for mivacurium than for atracurium or vecuronium.
本研究调查了米库氯铵（3倍ED95）与等效剂量的阿曲库铵和维库溴铵相比，对神经肌肉阻滞、插管条件及总体安全性的影响。经伦理护理委员会批准并获得知情同意后，对90例年龄在18至65岁的ASA I+II级择期耳鼻喉手术患者进行了研究。采用1.5mg/kg丙泊酚和0.2mg/kg阿芬太尼诱导麻醉，并通过持续输注丙泊酚（8至10mg·kg-1·h-1）和氧气中的氧化亚氮维持麻醉。在达到稳定麻醉后，患者接受单次注射米库氯铵（0.20mg/kg，n=30）、阿曲库铵（0.69mg/kg，n=30）或维库溴铵（0.14mg/kg，n=30）用于气管插管。给药后120秒尝试插管，并评估插管条件。使用外周神经刺激（四个成串刺激）记录肌肉松弛情况。在观察期内，监测组胺释放迹象、呼吸困难、心血管事件或其他不良迹象。与阿曲库铵（1.4±0.7分钟）或维库溴铵（1.3±0.3分钟）相比，米库氯铵的肌肉松弛起效时间更长（2.3±1.3分钟）。给药后120秒时，米库氯铵组仅有67%的病例插管条件为良好或非常好，而阿曲库铵组为90%，维库溴铵组为100%。米库氯铵组的恢复时间（DUR 25）（19.5±7.9分钟）比阿曲库铵组（54.7±6.6分钟）和维库溴铵组（44.3±8.6分钟）短。所有组的心率和血压相似。作为组胺释放迹象的面部潮红和轻度支气管痉挛在米库氯铵组（20%）和阿曲库铵组（23%）中比在维库溴铵组（3%）中更常见。与阿曲库铵和维库溴铵不同，米库氯铵诱导的神经肌肉阻滞恢复迅速。然而，3倍ED95剂量后米库氯铵的起效时间明显长于阿曲库铵或维库溴铵。
