摘要
目的 探讨不同性别患者预注顺阿曲库铵加快起效的半数有效剂量（ED50）.方法 择期拟在全身麻醉下行腹部手术的患者90例,年龄18～55岁,分为2组（n=45）：男性组（M组）和女性组（F组）.采用TOF-Watch SX型加速度肌松监测仪对尺神经行单次颤搐刺激,监测拇内收肌肌颤搐情况.静脉注射咪达唑仑0.04 mg/kg、芬太尼1 μg/kg,患者意识消失后开启加速度肌松监测仪,静脉注射顺阿曲库铵预注剂量,3 min后静脉注射芬太尼5 μg/kg、异丙酚2 mg/kg,静脉注射预注量后4 min,静脉注射顺阿曲库铵剩余插管剂量（3×ED95即0.15 mg/kg减去预注量）,当单刺激颤搐值与对照值的比值下降至10%,行气管插管.静脉输注异丙酚、瑞芬太尼,吸入异氟烷维持麻醉.预注量根据序贯法确定,预注量从5μg/kg（10%ED95）开始,各相邻剂量比值为1.2.记录给予预注量后4min时单刺激颤搐值与对照值的比值、90%起效时间、起效时间、最大阻滞程度、临床作用时间.计算预注顺阿曲库铵加快起效的ED50及其95%可信区间（CI）.结果 M组90%起效时间长于F组（P＜0.05）,其余肌松效应指标两组比较差异无统计学意义（P＞0.05）.预注顺阿曲库铵加快起效的ED50：男性为21.36μg/kg,95%CI为20.52～22.23μg/kg;女性为14.53 μg/kg,95%CI为13.77～15.33μg/kg,男性高于女性（P＜0.05）.结论 预注顺阿曲库铵加快起效的ED50：男性为21.36μg/kg,女性为14.53 μg/kg,男性高于女性.
Objective To investigate the median effective dose （ED50） of cisatracurium priming accelerating the onset of neuromuscular block in patients of different genders. Methods Ninety ASA Ⅰ or Ⅱ patients aged 18-55 yr undergoing elective abdominal operation under general anesthesia were divided into 2 groups （ n = 45 each）： male group （group M） and female group （group F）. Neuromuscular block was monitored with accelerograph F （TOF-Watch SX）. A single twitch stimulation of ulnar nerve was used to monitor neuromuscular function.Anesthesia was induced with midazolam 0.04 mg/kg and fentanyl 1 μg/kg. Accelerograph F was opened after the patients lost consciousness. The priming dose of cisatracurium was injected intravenously, then fentanyl 5 μg/kg and propofol 2 mg/kg were injected intravenously 3 min later and the left dose of cisatracurium for intubation was injected intravenously 4 min later. Tracheal intubation was performed when the ratio of the single twitch stimulation value to control value （T/Tc）. decreased to 10%. Anesthesia was maintained with iv infusion of propofol and remifentanil and inhalation of isoflurane. The priming dose of cisatracurium was determined by up-and-down sequential trial. The initial priming dose was set at 5 μg/kg. The ratio of two successive doses was 1.2. T/Tc, time to 90% block, onset time, maximal neuromuscular block and clinical duration were recorded 4 min after the administration of the priming dose. The ED50 and 95% confidence interval （CI） of cisatracurium priming required to accelerate the onset were caculated. Results Time to 90% block was significantly longer-in group M than in group F （P ＜0.05）. No significant difference was found in the other parameters among the groups. The ED50 and 95% CI of cisatracurium priming required to accelerate the onset were 21.36 μg/kg （95% CI 20.52-22.23 μg/kg）in group M and 14.53 μg/kg （95% CI 13.77-15.33 μg/kg） in group F. The ED50 was significantly higher in group M than in group F （ P ＜ 0.05）. Conclusion The ED50 of cisatracurium priming accelerating thd onset is 21.36 and 14.53 μg/kg in male and female respectively and it is significantly higher in male than in female.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2010年第8期900-903,共4页
Chinese Journal of Anesthesiology
