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題名 | 短效神經肌肉鬆弛劑Mivacurium和Suxamethonium在臨床麻醉插管之隨機比較研究=Neuromuscular Blockade for Tracheal Intubation: A Comparison of Mivacurium and Suxamethonium |
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作者 | 張家昇; 劉玉成; 涂坤村; 鄭鴻鈞; 陳坤堡; | 書刊名 | 中國醫藥雜誌 |
卷期 | 2:3 1997.09[民86.09] |
頁次 | 頁172-176 |
分類號 | 416.5 |
關鍵詞 | 氣管插管; 肌肉鬆弛劑; 神經肌肉傳導刺激器; 四連刺激反應; Tracheal intubation; Neuromscular relaxants: mivacurium; Suxamethonium; Neuromuscular stimulator; Train-of-four; |
語文 | 中文(Chinese) |
中文摘要 | 麻醉誘導時施行氣管插管術常需使用神經肌肉鬆弛劑來幫忙,去極化神經肌肉鬆弛劑suxamethonium,因其作用快,藥效短而被廣泛應用,但因其去極化特性具有很多嚴重副作用,甚至產生危及生命之併發症,早已不被建議使用,新的非去極化神經肌肉鬆弛劑一直在研發,希望能取代它以減少不幸之發生。mivacurium是一種新的非去極化神經肌肉鬆弛劑,也是具有作用快,藥效短之特性,不會產生心律不整,心跳停止等不良反應,尤其是恢復自然呼吸無須拮抗劑,可大為提高麻醉的安全性,極適用於短時間的手術麻醉,如即日手術,本實驗之目的在於評估其效果及安全性,以為日後推廣即日手術之使用參考。方法:44位ASA體位1-2級病患,隨機平均分為二組接受mivacurium 0.25 mg/kg(3倍抑制95﹪的抽動反應所需的mivacurium單一劑量,n=21)或suxamethonium 1 mg/kg以施行氣管插管術。在標準誘導麻醉後,利用神經肌肉傳導監視器每15秒利用4個連續電子式的刺激(2Hz)尺神經,產生所謂一個train-of-four反應,同時測量內縮拇肌肌動電流描記術(EMG)的反應結果來記錄兩者作用速度、最大阻斷程度、作用維持時間、恢復時間及插管優劣性。結果:顯示在作用速度suxamethoium優於mivacurium(0.8±0.2 vs 2.7±0.6),但在最大神經肌肉阻斷程度、插管優劣度兩者無顯著差異,而mivacurium在作用維持時間,恢復時間及副作用發生率比suxamethonium更適合短時間的手術麻醉。結論:依文獻我們可利用促mivacurium插管作用速度,由本實驗知其效果和安全性,在成人手術麻醉是一良好取代suxamethonium的選擇。 |
英文摘要 | Background: Mivacurium, a new nondepolarizing muscle relaxant, has a rapid onset of activity and may be suitable as a component of a rapid-sequence induction of anesthesia. We evaluated a dose of 0.25 mg/kg of mivacurium for onset and duration of effect at the adductor pollicis muscle and compared these characteristics with those of suxamethonium 1 mg/kg. Methods: Forty-four patients aged 19 to 49 years, of ASA (The American Society of Anesthesiologists) physical status 1to 2, were randomly allocated to receive suxamethonium (1mg/kg) (n=23) or mivacurium (0.25 mg/kg) (n=21) during surgery. Anesthesia was induced and maintained with fentanyl and propofol. Neuromuscular transmission was monitored by electromyography (EMG) at the adductor pollicis muscle of each patient. Muscle activity was evoled with supramaximal stimuli in a train-of-four every 15 seconds to the ulnar nerve. The following variableds were recorded as a database for neuromuscular measurement: onset time, maximal block, duration, recovery index, and intubation condition. Results: The onset time of mivacurium was found to be slower than that of suxamethonium(2.7±0.6 vs 0.8±0.2 minutes). The maximal block and intubation condition showed no statistical difference between the two groups studied. The duration time and recovery index showed that mivacurium was more suitable for ambulatory surgery. Conclusion: Offering the priming technique to hasten the onset time could make mivacurium a good altermative of suxamethonium and provide for safer and more effective maintenance of the patient. |
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