摘要
目的比较静脉间断推注、持续输注、靶控输注顺式阿曲库铵在肾移植麻醉中应用效果,选出适合的方式。方法拟行肾移植手术的患者45例,年龄30~65岁,美国标准协会(american standard assciation,ASA)Ⅱ或Ⅲ级,随机分为间断推注组(A组)、持续输注组(B组),靶控输注组(C组),每组15例。采用全凭静脉全身麻醉。用TOF-Watch肌松监测仪以间隔12 s连续监测4个成串刺激尺神经后拇内收肌的收缩反应。麻醉诱导后,A组及B组静脉注射顺式阿曲库铵0.3 mg/kg,C组采用TCI-I泵靶控输注顺式阿曲库铵,靶浓度为2.0μg/ml,待TOF中T1最低时气管插管。A组45 min间断追加顺式阿曲库铵0.1~0.3 mg/kg,B组则持续输注顺式阿曲库铵1~3μg/kg·min,C组则随时调整顺式阿曲库铵靶控输注浓度,使术中肌松维持T1<10%。三组患者预计手术结束前30 min停用顺式阿曲库铵。记录顺式阿曲库铵起效时间,气管插管评级,恢复指数,TOFr 0.9时间,停药至拔除气管导管时间,丙泊酚、瑞芬太尼、顺式阿曲库铵总用量以及药物相关的不良反应。结果与A组比较,B组及C组恢复指数下降,TOFr恢复至0.9时间短,顺式阿曲库铵用量减少,差异有统计学意义(P<0.05),C组在气管插管条件较好,差异有统计学意义(P<0.05);与B组比较,C组在气管插管优评分,TOFr恢复至0.9时间,顺式阿曲库铵用量方面差异有统计学意义(P<0.05)。三组患者均无药物相关不良反应。结论靶控输注顺式阿曲库铵比较适合肾移植麻醉。
Objective To investigate the effects of cisatracurium in different injection methods for anesthesia during renal transplantation. Methods Forty five ASA II or mend-stage renal failure patients（aged 30-65 yr） to be subject to renal transplantation were randomly divided into 3 groups（n=15,for each）：intermittent bolus injection group （group A）,eontinuous infusion group （group B） and target controlled infusion （TCI） group （group C）. The total intravenous anesthesia was used during surgery.Neuromuscular block following cisatracurium was monitored by TOF -Watch monitor with train-of- four （TOF） stimulations on ulnar nerve at 12S interval. During induction of anesthesia,the patients in group A and B,eisatracurium 0.3mg/kg were injected intravenously and group C TCI cisatracurium with target concentration 2.0μg/ml;T1〈10% was maitained,intermittent boluses （intravenously injection） of cisatracurium 0.1-0.3mg/kg were given to group A,the infusion rate was manuany adjusted in group B,the target concentration was manuany adjusted in group C. The use of muscle relaxants was stopped immediately before the end of operation. The onset time,the condition of intubation,time for the operation,recovery index,the recovery time of TOFr 0.9,the time from stopping injection to extuhation and the consumption of cisatracurium was recorded. Results Compared with group A,recovery index was shorter,the recovery time of TOFr 0.9 declined and the consumption of cisatracurium was lower in group B and C （P〈0.05）. The condition of intubation was better in group C （P〈0.05）. Compared with group B,the condition of intubation was better,the recovery time of TOFr 0.9 declined and the consumption of cisatracurium was lower in group C （P〈0.05）. Conclusion TCI cisatracurium is more suit for anesthesia during renal transplantation.
出处
《实用医药杂志》
2017年第8期684-686,689,共4页
Practical Journal of Medicine & Pharmacy
基金
广东省临床重点专科建设资金资助项目[粤卫(2011)144]
关键词
顺式阿曲库铵
靶控输注
肾移植
Cisatracurium
Target controlled infusion
Renal transplantation
