[1]刘湘钰,王晖玥,梁嘉敏,等.新斯的明和抗胆碱药拮抗老年人罗库溴铵残余肌松的合适剂量研究[J].新乡医学院学报,2020,37(1):039-43.[doi:10.7683/xxyxyxb.2020.01.010]
　LIU Xiangyu,WANG Huiyue,LIANG Jiamin,et al.Appropriate dose of neostigmine and anticholinergic drugs to antagonize rocuronium residual muscle relaxation in the senile patients[J].Journal of Xinxiang Medical University,2020,37(1):039-43.[doi:10.7683/xxyxyxb.2020.01.010]
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新斯的明和抗胆碱药拮抗老年人罗库溴铵残余肌松的合适剂量研究
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年1
页码:
039-43
栏目:
临床研究
出版日期:
2020-01-05

文章信息/Info

Title:
Appropriate dose of neostigmine and anticholinergic drugs to antagonize rocuronium residual muscle relaxation in the senile patients
作者:
刘湘钰; 王晖玥; 梁嘉敏; 胡顺晴; 张新建
（广州中医药大学第三附属医院麻醉科，广东　 广州　510378）
Author(s):
LIU Xiangyu; WANG Huiyue; LIANG Jiamin; HU Shunqing; ZHANG Xinjian
(Department of Anesthesiology,the Third Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510378,Guangdong Province,China)
关键词:
罗库溴铵; 新斯的明; 抗胆碱药; 药效学; 神经肌肉阻滞; 血流动力学; 老年人
Keywords:
rocuronium bromide; neostigmine; anticholinergics; pharmacodynamics; neuromuscular blockade; hemodynamics; the elderly
分类号:
R971+.2
DOI:
10.7683/xxyxyxb.2020.01.010
文献标志码:
A
摘要:
目的　探讨新斯的明与阿托品或盐酸戊乙奎醚混合液拮抗老年人罗库溴铵神经肌肉阻滞（NMB）单刺激（SS）数值恢复至25%的最佳剂量及配伍方式。方法　选择2017年10月至2019年6月于广州中医药大学第三附属医院择期行全身麻醉下手术的老年患者135例，美国麻醉学家学会分级Ⅰ～Ⅲ级，根据新斯的明剂量分为30 μg·kg-1新斯的明组（N30组）、35 μg·kg-1新斯的明组（N35组）和40 μg·kg-1新斯的明组（N40组） 3个大组，每组45例；每个大组再根据新斯的明与阿托品（新斯的明与阿托品剂量比2∶1、3∶1）或盐酸戊乙奎醚（新斯的明与盐酸戊乙奎醚剂量比2︰1）剂量比分为3个小组，共9个小组（N301组、N302组、N303组、N351组、N352组、N353组、N401组、N402组、N403组），每组15例。麻醉过程中使用Veryark-TOF肌松监测仪进行肌松监测，术中罗库溴铵持续输注调控SS数值在10％以下，手术结束后SS恢复至25％时给予新斯的明配伍阿托品或盐酸戊乙奎醚进行拮抗，观察新斯的明拮抗与抗胆碱药配伍后罗库溴铵药效动力学参数和拮抗前后不同时间点血流动力学变化。结果　9组患者罗库溴铵用量、术中体温及手术时间比较差异均无统计学意义（P＞0.05）。N30组（N301组、N302组、N303组）、N35组（N351组、N352组、N353组）、N40组（N401组、N402组、N403组）组内SS自10％自然恢复至25％的时间（SST10-25）、SS恢复指数（SSRI）、自拮抗后TOFr恢复到0.70（Tr0.70）和0.90时间（Tr0.90）比较差异无统计学意义（P＞0.05）；N30组、N35组和N40组各组间SST10-25比较差异无统计学意义（P＞0.05）；N35组和N40组患者SSRI、Tr0.70、Tr0.90小于N30组（P＜0.05），N40组患者SSRI、Tr0.70、Tr0.90小于N35组（P＜0.05）。应用新斯的明和阿托品配伍的各组（N301组、N302组、N351组、N352组、N401组、N402组）主要表现为拮抗后1、2、3、4 min心率、平均动脉压升高（P＜0.05）；盐酸戊乙奎醚配伍的各组（N303、N353、N403）患者心率、平均动脉压稳定（P＞0.05）。结论　对于66～80岁老年人，当NMB的SS数值恢复至25%时应用新斯的明配伍抗胆碱药拮抗罗库溴铵的残余肌松作用，新斯的明40 μg·kg-1伍用阿托品17.5 μg·kg-1或盐酸戊乙奎醚20 μg·kg-1是合适的配伍剂量。
Abstract:
Objective　To study the appropriate dose and compatibility of neostigmine with atropine or penehyclidine hydrochloride in antagonizing 25% rocuronium bromide neuromuscular block (NMB) single stimulation (SS) in the senile patients.Methods　A total of 135 patients underwent elective surgery with general anesthesia（American society of anesthesiologists grade Ⅰ-Ⅲ）.According to the dose of neostigmine,the patients were divided into 30 μg·kg-1 neostigmine group (N30 group),35 μg·kg-1 neostigmine group (N35 group) and 40 μg· kg-1 neostigmine group (N40 group),with 45 cases in each group.According to the dose ratio of neostigmine to atropine (2∶1,3∶1) or penehyclidine hydrochloride (2∶1),each jumpbogroup was divided into three groups,nine groups (N301,N302,N303,N351,N352,N353,N401,N402,N403 groups) in total,with 15 cases in each group.The muscle relaxation was monitored by Veryak-TOF muscle relaxation monitor during anesthesia.Intraoperative SS was less than 10% through continuous infusion of rocuronium.when SS recovered to 25% after operation,the neostigmine and atropine or penehyclidine hydrochloride were used to antagonize rocuronium residual muscle relaxation.The pharmacokinetic parameters of rocuronium after the combination of neostigmine and anticholinergics and the hemodynamic changes at different time points before and after antagonism were observed. Results　There was no significant difference in the dosage of rocuronium,intraoperative temperature and operation time among the nine groups (P>0.05).The intra-subgroup comparison in the N30 group(among the N301 group,N302 group and N303 group),N35 group(among the N351 group,N352 group and N353 group) and N40 group(among the N401 group,N402 group and N403 group) showed that there was no significant difference in the time of SS recovery from 10% to 25% (SST10-25),SS recovery index (SSRI),the time of TOFr recovered to 0.70 (Tr0.70) after antagonism,the time of TOFr recovered to 0.90 (Tr0.90) after antagonism(P>0.05).There was no significant difference in SST10-25 among the N30 group,N35 group and N40 group (P>0.05).The SSRI,Tr0.70 and Tr0.90 in the N35 group and N40 group were less than those in the N30 group (P<0.05);and the SSRI,Tr0.70 and Tr0.90 in the N40 group were less than those in the N35 group (P<0.05).The groups using neostigmine and atropine(N301 group,N302 group,N351 group,N352 group,N401 group,N402 group) showed that the heart rate and mean arterial pressure increased at 1,2,3 and 4 minutes after antagonism (P<0.05).The heart rate and mean arterial pressure were stable in the patients of the groups using neostigmine and penehyclidine hydrochloride (N303 group,N353 group,N403 group) (P>0.05).Conclusions　In the elderly aged 66-85 years old,when the SS of NMB restored to 25%,40 μg·kg-1 neostigmine combined with 17.5 μg·kg-1 atropine or 20 μg·kg-1 penehyclidine hydrochloride is the appropriate dosage to antagonizing the residual muscular relaxation effect of rocuronium bromide.

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更新日期/Last Update: 2020-01-05