本文選題：順式阿曲庫銨 + 起效時(shí)間��； 參考：《遵義醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:比較三種常用加快順式阿曲庫銨(Cis)起效時(shí)間的方法,尋找起效最快且插管條件最優(yōu)的方法,為臨床工作中合理使用Cis提供理論參考。方法:選取擬在全身麻醉下行擇期手術(shù)的患者120例,美國麻醉醫(yī)師協(xié)會(ASA)評級為Ⅰ~Ⅱ級,年齡:18~65歲,體質(zhì)指數(shù)(BMI):18.5~24.9kg/m2,Mallampati分級:Ⅰ~Ⅱ級,非困難氣道且無反流誤吸高風(fēng)險(xiǎn),無發(fā)熱、嚴(yán)重貧血、藥物食物過敏,無肝、腎、心肺系統(tǒng)疾患,近期未服用影響肌松劑作用的藥物,術(shù)前無嚴(yán)重高血壓,心率:60-110次/min,術(shù)前3個(gè)月監(jiān)測肌松部位無手術(shù)、外傷或穿刺史。采取隨機(jī)數(shù)字表法將120例擬觀察的受試者隨機(jī)均分為4組,對照組(C組)、羅庫溴銨預(yù)注組(R組)、聯(lián)合應(yīng)用麻黃堿組(E組)以及大劑量組(L組),每組30例。各組全麻誘導(dǎo)均采取靜脈推注鹽酸戊乙奎醚0.01 mg/kg,咪達(dá)唑侖0.05 mg/kg,芬太尼4μg/kg,待患者意識消失后完成肌松監(jiān)測儀定標(biāo),R組、E組分別給予羅庫溴銨0.06mg/kg或麻黃堿70μg/kg,C組與L組則給予0.9%Na Cl做對照,四組于相同時(shí)點(diǎn)給予依托咪酯0.3mg/kg,最后C組、R組、E組、L組分別按0.15mg/kg、0.14mg/kg、0.15mg/kg、0.20mg/kg靜脈推注Cis。采用四個(gè)成串刺激模式(TOF)予以監(jiān)測肌松變化。麻醉維持采用靜脈泵入瑞芬太尼(0.025~0.4μg·kg-1·min-1)及丙泊酚(4~12 mg·kg-1·h-1),吸入七氟烷(0.6~1.0 MAC)。記錄病人入室穩(wěn)定后(T1)、氣管插管前(T2)、插管即刻(T3)、氣管插管后1min(T4)、2min(T5)、3min(T6)、4min(T7)、5min(T8)時(shí)的平均動脈壓(MAP)、心率(HR)、動脈血氧飽和度(Sp O2);記錄起效時(shí)間(從肌松劑注射結(jié)束到TOF計(jì)數(shù)為0的時(shí)間)、持續(xù)時(shí)間(從肌松劑注射結(jié)束到TOF計(jì)數(shù)恢復(fù)到2的時(shí)間)、氣管插管即刻TOFr值;評估氣管插管的條件并計(jì)算氣管插管優(yōu)良率;觀察病人麻醉期間是否發(fā)生皮膚潮紅、氣管痙攣以及心律失常等不良反應(yīng)。結(jié)果:本試驗(yàn)最終納入104例(C組、E組各27例,R組及L組各25例)。各組患者在性別、年齡、BMI、術(shù)前體溫上的比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。各組在麻醉誘導(dǎo)期間的不同時(shí)點(diǎn)的MAP有差別(F=76.116,P=0.000),與其他時(shí)點(diǎn)相比較,T3時(shí)MAP明顯增高;在T3時(shí)點(diǎn)與R組相比,E組MAP顯著增高,差異有統(tǒng)計(jì)學(xué)意義(P=0.033);不同時(shí)點(diǎn)的MAP在不同隨機(jī)分組上無差別(F=1.854,P=0.12);各組MAP在不同時(shí)點(diǎn)的變化趨勢上無差別(F=0.535,P=0.659);各組在不同時(shí)點(diǎn)上的心率有差別(F=45.319,P=0.000),與其它時(shí)點(diǎn)相比,T3時(shí)HR明顯增高,T2和T8時(shí)明顯降低;不同時(shí)點(diǎn)的HR在不同隨機(jī)分組上無差別(F=1.707,P=0.27);各組HR在不同時(shí)點(diǎn)的變化趨勢上無差別(F=1.738,P=0.164)。各組不同時(shí)點(diǎn)上的Sp O2有差別(F=209.549,P=0.000),與其它時(shí)點(diǎn)相比,T1時(shí)顯著降低;不同時(shí)點(diǎn)的Sp O2在不同隨機(jī)分組上無差別(F=0.792,P=0.731);各組Sp O2在不同時(shí)點(diǎn)的變化趨勢上無差別(F=0.299,P=0.826)。與C組相比,其余各組在起效時(shí)間都顯著加快,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。與E組相比,R組起效時(shí)間更快,差異有統(tǒng)計(jì)學(xué)意義(P=0.003);L組與E組、R組分別比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。在肌松藥持續(xù)時(shí)間上,與其它各組相比,L組顯著延長,差異有統(tǒng)計(jì)學(xué)意義(P0.05),其余三組間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。氣管插管時(shí)的TOFr值,與其余組別相比,R組明顯減小,差異有統(tǒng)計(jì)學(xué)意義(P0.05);與C組、E組比較,L組的TOFr值減小,差異有統(tǒng)計(jì)學(xué)意義(P0.05);而C、E組之間的比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。各組受試者插管條件的比較,四組間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。各組受試者在全麻誘導(dǎo)及維持期間均未發(fā)生不良反應(yīng)。結(jié)論:在三種加快順式阿曲庫銨起效時(shí)間的方法中,羅庫溴銨預(yù)注法加快起效時(shí)間的效果最佳,獲得插管條件優(yōu)良,誘導(dǎo)期平穩(wěn),無顯著不良反應(yīng),可在臨床大多數(shù)患者中推廣使用。
[Abstract]:Objective: To compare the three methods used to speed up the onset time of CIS atracurium (Cis), to find the fastest and best intubation conditions, and to provide theoretical reference for the rational use of Cis in clinical work. Methods: 120 patients who were planned to undergo elective surgery under general anesthesia were selected and the American anesthesiologist Association (ASA) was rated as grade I ~ II, age: 1 8~65 years, body mass index (BMI): 18.5~24.9kg/m2, Mallampati classification: Grade I ~ II, non difficult airway and no reflux aspiration high risk, no fever, severe anemia, drug food allergy, liver, kidney, cardiopulmonary disease, not taking drugs to influence muscle relaxant, no severe hypertension, heart rate: 60-110 times /min, 3 months before operation to monitor the muscle There were no surgery, trauma or history of puncture. 120 subjects were randomly divided into 4 groups, the control group (group C), rocuronium preinjection group (group R), the combined use of ephedrine group (group E) and the large dose group (group L), 30 cases in each group. All the groups were induced by intravenous injection of amyl hydrochloric acid 0.01 mg/kg, Midda. Zolun 0.05 mg/kg, fentanyl 4 mu g/kg, after the patients' consciousness disappeared to complete the calibration of muscle relaxation monitor, group R, group E were given rocuronium 0.06mg/kg or ephedrine 70 mu g/kg, C group and L group were given 0.9%Na Cl contrast, the four groups were given etomidate 0.3mg/kg at the same time. 0.20mg/kg intravenous injection (Cis.) was used to monitor muscle relaxants by four modes of stimulation (TOF). The anesthesia was maintained by intravenous infusion of remifentanil (0.025~0.4 mu g. Min-1) and propofol (4~12 mg kg-1. H-1), and inhaled seven fluorothane (0.6~1.0). After 1min (T4), 2min (T5), 3min (T6), 4min (T7), 5min (T8), the average arterial pressure (MAP), heart rate (HR) and arterial oxygen saturation (from the end of the muscle relaxant to the count of 0), the duration (from the end of the muscle relaxant to the count of 2), the immediate value of the tracheal intubation, and the evaluation of tracheal intubation The condition was calculated and the excellent rate of tracheal intubation was calculated; the adverse reactions of skin flushing, trachea spasm and arrhythmia during anesthesia were observed. Results: the test was finally included in 104 cases (group C, 27 cases in group E, group R and 25 cases in group L). There was no statistical difference between the groups in sex, age, BMI, and preoperative temperature (P0.05). The different MAP in each group during the induction of anesthesia was different (F=76.116, P=0.000). Compared with other time points, MAP was significantly higher at T3. At T3 point, the MAP significantly increased in E group, and the difference was statistically significant (P=0.033). There was no difference in the trend (F=0.535, P=0.659); the heart rate of each group at different points was different (F=45.319, P=0.000). Compared with other time points, HR increased obviously at T3 and decreased obviously at T2 and T8, and there was no difference between different random groups (F=1.707, P= 0.27). The Sp O2 of each group at different points was different (F=209.549, P=0.000), compared with the other time points, the T1 decreased significantly; the Sp O2 at different points had no difference (F=0.792, P=0.731) in different random groups (F=0.792, P=0.731); Sp O2 in each group had no difference in the variation trend of the same point. Compared with the group, the rest of the other groups increased significantly at the onset time, The difference had statistical significance (P0.05). Compared with group E, the onset time of group R was faster, and the difference was statistically significant (P=0.003). The difference was not statistically significant (P0.05) in group L and E group. In the duration of muscle relaxant, the L group was significantly longer than the other groups, and the difference was statistically significant (P0.05), and there was no difference between the other three groups. Statistical significance (P0.05). Compared with other groups, the TOFr value of tracheal intubation decreased significantly in group R, and the difference was statistically significant (P0.05). Compared with group C and group E, the TOFr value of L group decreased, the difference was statistically significant (P0.05); while the comparison between C, E group was not statistically significant (P0.05). The comparison of the intubation conditions of each group, the difference between the four groups There was no statistical significance (P0.05). There was no adverse reaction during the induction and maintenance of general anesthesia. Conclusion: in the three methods to accelerate the onset time of CIS atracurium, rocuronium preinjection method has the best effect to speed up the onset time. It has excellent intubation conditions, stable induction period and no significant adverse reactions, which can be used in clinical large scale. It is widely used in most patients.

【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614

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