摘要
５２例低温体外循环心内直视术后进行ＩＣＵ监护的患者必须行持续人工通气，全部病例选用肌松剂ＡＴＣ应用，未用或少用镇静药，效果满意。５２例均于进入ＩＣＵ立即起用ＡＴＣ微泵滴注，用量为３ｕｓ－６ｕｇ／ｋｇ／ｍｉｎ，总使用时间５～４８小时，循环稳定，停用ＡＴＣ６０～９０分钟即可拔除气管导管，全部病例无呼吸抑制并发症，未用拮抗药。本组用ＡＴＣ后，清醒时能睁眼，意识清楚，合作，循环指标稳定，机械通气正常，四肢肌松，四串电刺激器在Ｔ３／Ｔ１０．７以下，未用镇静剂３０例，于晚间用少量镇静药入睡２２例。本组进入ＩＣＵ危重患者应用ＡＴＣ有如下优点：（１）清醒合作，不燥动，减少全身氧耗。（２）保持机械通气稳定，氧供正常，有利心脏功能恢复。（３）ＡＴＣ具有作用时间短，对心肌及循环无影响；不依赖肝肾排泄，故对肝肾无毒性，且无蓄积作用和残留肌松作用。（４）持续用药减少间断用镇静药的患者燥动对抗呼吸机等不良影响。本组实践证明，在严格监护ＩＣＵ危重患者应用ＡＴＣ对重要器官无不良反应，停药短时内恢复肌力，顺利脱机。
Fifty two patients entered ICU after heart operation with cardiopulmonary bypass.These patients with ventilation atracurium (ATC) were given 3μg～6μg/kg/min for 5￣48 hours. No complications happened.After ATC was used, the patients could open eyes, and cooperate with the doctor when they regain consciousness.The circulation index was normal.The limbs of these patients relaxed. In the 52 cases,30 didn′t use sedatives, and 22 used senall dose of sedatives for sleep at night.We conclude that ATC does not require hepatic or renal function for termination of effect and action is terminated by the “Hoffman elimination” and ester hydrolysis.The time of effect is short and there is no cumulation effect. There is no vagal or ganglionic blocking activity,so ATC does not influence circulation and myocardial function.Maintenance relexation keeps ventilation steady and oxygen supply normal.
出处
《中华外科杂志》
CAS
CSCD
北大核心
1997年第2期125-126,共2页
Chinese Journal of Surgery
