恶性肿瘤对顺阿曲库铵肌松效应的影响
Effect of malignant tumor on neuromuscular block of cisatracurium
目的 探讨恶性肿瘤对顺阿曲库铵肌松效应的影响.方法 选择头颈部肿瘤患者60例,ASA分级Ⅰ或Ⅱ级,年龄18~64岁,分为4组(n=15),良性肿瘤组(B组,3×ED95);45例恶性肿瘤患者按顺阿曲库铵使用剂量分为C1组(2×ED95)、C2组(3×ED95)和C3组(4 × E95).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,监测拇内收肌颤搐情况.麻醉诱导:靶控输注异丙酚(血浆靶浓度3μg//ml)和瑞芬太尼(效应室靶浓度3 ng/ml),患者意识消失后开启加速度肌松监测仪.B组静脉注射顺阿曲库铵0.15 mg/kg行气管插管.C1组、C2组和C3组分别静脉注射顺阿曲库铵0.10、0.15和0.20mg/kg行气管插管.记录顺阿曲库铵起效时间,临床作用时间、T/Tc恢复至75%的时间及其恢复指数.结果 与B组比较,C2组顺阿曲库铵临床作用时间、T/Tc恢复至75%的时间及恢复指数延长(P<0.05),起效时间差异无统计学意义(P>0.05).与C1组比较,C2组和C3组顺阿曲库铵起效时间缩短,临床作用时间、T/Tc恢复至75%的时间延长(P<0.05),恢复指数差异无统计学意义(P>0.05).与C2组比较,C3组顺阿曲库铵起效时间缩短,临床作用时间、T/Tc恢复至75%时间延长(P<0.05),恢复指数差异无统计学意义(P>0.05).结论 恶性肿瘤患者应用顺阿曲库铵肌松效应的维持和恢复时间延长.
更多Objective To investigate the effect of malignant tumor on neuromuscular block of cisatracurium. Methods Sixty ASA Ⅰ or Ⅱ patients with head and neck neoplasms (15 cases with benign tumor, 45 with malignant tumor), aged 18-64 yr, were randomly divided into 4 groups ( n = 15 each): Ⅰ benign tumor group (group B,3 × ED95 ); Ⅱ -Ⅳ different dose cisatracurium group (group C1 (2 × ED95 ), C2 (3 × ED95 ) and C3 (4 ×ED95)). Neuromuscular block was assessed with accelerograph F (TOF-watch SX). Single stimulation of ulnar nerve was used. Anesthesia was induced with TCI of propofol (target plasma concentration 3 μg/ml) and remifentanil (target effect-site concentration 3 ng/ml). Tracheal intubation was facilitated with cisatracurium 0.15 mg/kg in group B, and with cisatracurium 0.10, 0.15 and 0.20 mg/kg in group C1, C2 and C3 respectively. The onset time, clinical duration, time for recovery of T/Tc to 75 % and recovery index were recorded. Results The clinical duration, time for recovery of T/Tc to 75 % and recovery index were significantly longer in group C2 than in group B (P < 0.05). The onset time was significantly shorter, while the clinical duration and time for recovery of T/Tc to 75% were significantly longer in group C2 and C3 than in group C1 , and in group C3 than in group C2 ( P <0.05) .Conclusion The duration of action and recovery times of cisatracurium were prolonged in patients with malignant tumor.
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