• 四川大學(xué)華西醫(yī)院麻醉科,四川成都 610041;

目的:旨在評(píng)價(jià)預(yù)注維庫溴銨聯(lián)合稀釋依托咪酯減輕依托咪酯全麻誘導(dǎo)中肌陣攣的效果。方法:本研究為前瞻性、雙盲、隨機(jī)對(duì)照研究。80名ASA I-II級(jí)、年齡18～60歲、擬行膽囊切除術(shù)的全麻患者被隨機(jī)分為4組:組1,預(yù)注維庫溴銨0.01 mg/kg;組2,依托咪酯用生理鹽水由2 mg/mL 稀釋為1 mg/mL;組3,預(yù)注維庫溴銨聯(lián)合稀釋依托咪酯;組4,生理鹽水對(duì)照組+非稀釋依托咪酯組。根據(jù)分組給予患者預(yù)注維庫溴銨0.01 mg/kg或同等量的生理鹽水,觀察并詢問患者有無呼吸困難,并記錄呼吸頻率和脈搏氧飽和度(SpO2)。3分鐘后推注稀釋或無稀釋依托咪酯0.3 mg/kg,詢問患者有無注射痛并做疼痛評(píng)分,觀察有無肌陣攣并評(píng)估其程度。2分鐘后給予維庫溴銨0.1 mg/kg、芬太尼3 μg/kg和丙泊酚1 mg/kg行氣管插管。實(shí)驗(yàn)期間同時(shí)記錄無創(chuàng)動(dòng)脈血壓(BP)和心率(HR)。結(jié)果:組1和組4分別有2例(10%)和3例(15%)患者述輕度注射疼痛,而組2和組3無患者述注射疼痛。組1、組2和組3肌陣攣的發(fā)生率明顯低于組4(30%、40%和15% vs 70%,P lt;0.05)。且組1、組2和組3肌陣攣的程度多為輕中度,而組4多為中重度。四組患者均未述任何呼吸困難,呼吸頻率無明顯降低,SpO2無明顯變化。四組患者BP和HR變化一致,無明顯差別。結(jié)論:預(yù)注小劑量維庫溴銨或稀釋依托咪酯可明顯降低依托咪酯引起肌陣攣的發(fā)生率并減輕其程度。且這兩種方法聯(lián)合應(yīng)用比單獨(dú)應(yīng)用效果更佳,具有一定程度的協(xié)同作用。

引用本文： 余海,方利群,杜潤(rùn)滋,張偉義,朱達(dá),劉斌. 預(yù)注維庫溴銨聯(lián)合稀釋依托咪酯減輕依托咪酯全麻誘導(dǎo)中肌陣攣的臨床研究. 華西醫(yī)學(xué), 2009, 24(8): 1988-1991. doi: 復(fù)制

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2. HUETER L, SCHWARZKOPF K, SIMON M, et al. Pretreatment with sufentanil reduces myoclonus after etomidate[J]. Acta Anaesthesiol Scand, 2003, 47(4): 482-4.
3. KELSAKA E, KARAKAYA D, SARIHASAN B, et al. Remifentanil pretreatment reduces myoclonus after etomidate[J]. J Clin Anesth, 2006, 18(2): 83-6.
4. SCHWARZKOPF K R, HUETER L, SIMON M, et al. Midazolam pretreatment reduces etomidateinduced myoclonic movements[J]. Anaesth Intensive Care, 2003, 31(1): 18-20.
5. HüTER L, SCHREIBER T, GUGEL M, et al. Lowdose intravenous midazolam reduces etomidateinduced myoclonus: a prospective, randomized study in patients undergoing elective cardioversion[J]. Anesth Analg, 2007, 105(5): 1298-302.
6. CHOI J M, CHOI IC, JEONG Y B, et al. Pretreatment of rocuronium reduces the frequency and severity of etomidateinduced myoclonus[J]. J Clin Anesth, 2008, 20(8): 601-4.
7. TUNCALI B, KARCI A, TUNCALI B E,et al. Dilution of rocuronium to 05 mg/mL with 09% NaCl eliminates the pain during intravenous injection in awake patients[J]. Anesth Analg, 2004, 99(3): 740-3.
8. YU H, YANG X Y, ZHANG X, et al. The effect of dilution and prolonged injection time on fentanylinduced coughing[J]. Anaesthesia, 2007, 62(9): 919-22.
9. SOSIS M. On the use of vecuronium 001 mg/kg to prevent suxamethoniuminduced myalgia[J]. Acta Anaesthesiol Scand, 1991, 35(1): 92.
10. SCHWARZ S, ILIASW, LACKNER F, et al. Rapid tracheal intubation with vecuronium: the priming principle[J]. Anesthesiology, 1985, 62(4): 388-91.
11. REDDY R V, MOORTHY S S, DIERDORF S F, et al. Excitatory effects and electroencephalographic correlation of etomidate, thiopental, methohexital, and propofol[J]. Anesth Analg, 1993, 77(5): 1008-11.
  1. 1. DOENICKE A W, ROIZEN M F, KUGLER J, et al.Reducing myoclonus after etomidate[J]. Anesthesiology, 1999, 90(1): 113-9.
  2. 2. HUETER L, SCHWARZKOPF K, SIMON M, et al. Pretreatment with sufentanil reduces myoclonus after etomidate[J]. Acta Anaesthesiol Scand, 2003, 47(4): 482-4.
  3. 3. KELSAKA E, KARAKAYA D, SARIHASAN B, et al. Remifentanil pretreatment reduces myoclonus after etomidate[J]. J Clin Anesth, 2006, 18(2): 83-6.
  4. 4. SCHWARZKOPF K R, HUETER L, SIMON M, et al. Midazolam pretreatment reduces etomidateinduced myoclonic movements[J]. Anaesth Intensive Care, 2003, 31(1): 18-20.
  5. 5. HüTER L, SCHREIBER T, GUGEL M, et al. Lowdose intravenous midazolam reduces etomidateinduced myoclonus: a prospective, randomized study in patients undergoing elective cardioversion[J]. Anesth Analg, 2007, 105(5): 1298-302.
  6. 6. CHOI J M, CHOI IC, JEONG Y B, et al. Pretreatment of rocuronium reduces the frequency and severity of etomidateinduced myoclonus[J]. J Clin Anesth, 2008, 20(8): 601-4.
  7. 7. TUNCALI B, KARCI A, TUNCALI B E,et al. Dilution of rocuronium to 05 mg/mL with 09% NaCl eliminates the pain during intravenous injection in awake patients[J]. Anesth Analg, 2004, 99(3): 740-3.
  8. 8. YU H, YANG X Y, ZHANG X, et al. The effect of dilution and prolonged injection time on fentanylinduced coughing[J]. Anaesthesia, 2007, 62(9): 919-22.
  9. 9. SOSIS M. On the use of vecuronium 001 mg/kg to prevent suxamethoniuminduced myalgia[J]. Acta Anaesthesiol Scand, 1991, 35(1): 92.
  10. 10. SCHWARZ S, ILIASW, LACKNER F, et al. Rapid tracheal intubation with vecuronium: the priming principle[J]. Anesthesiology, 1985, 62(4): 388-91.
  11. 11. REDDY R V, MOORTHY S S, DIERDORF S F, et al. Excitatory effects and electroencephalographic correlation of etomidate, thiopental, methohexital, and propofol[J]. Anesth Analg, 1993, 77(5): 1008-11.