右美托咪定对癫痫患者顺式阿曲库铵肌松效应的影响

目的：明确右美托咪定对癫痫患者顺式阿曲库铵肌松效应的影响。方法：选择需行择期神经外科手术的癫痫患者60例，年龄18～59岁，拟于全身麻醉下进行，ASA分级Ⅰ-Ⅱ级，按照右美托咪定最大起效时间分为三组（n=20）：右美托咪定输注后即刻诱导组（A组）、右美托咪定输注后15 min诱导组（B组）和输注生理盐水组（C组）。采用肌松监测仪监测神经肌肉传导功能，于TOF模式（波宽0.2 ms、频率2 Hz、串间间隔12 s、刺激电流70 mA）刺激尺神经。A组患者入室后给予右美托咪定1 μg/kg，10 min泵注结束后即刻开始麻醉诱导；B组患者入室后给予右美托咪定1 μg/kg，10 min泵注结束，15 min后开始麻醉诱导；C组患者10 min内泵注同等毫升生理盐水后即刻开始诱导，麻醉诱导时静脉注射顺式阿曲库铵0.15 mg/kg，当T1达最大抑制时行气管内插管，采用改良法评价气管插管条件。术中当T1恢复至25%时，静脉注射顺式阿曲库铵0.05 mg/kg。记录顺式阿曲库铵起效时间（Tonset）、高峰时间（Tpeak）、25%恢复时间（T25%）、25%～50%恢复时间（T25-50%）、50%～75%恢复时间（T50-75%）、75%～100%恢复时间（T75-100%）。记录手术时间、麻醉时间、补液量，记录丙泊酚、瑞芬太尼和顺式阿曲库铵总用量并计算单位体质量用量。结果：3组患者Tonset、Tpeak、T25%、T25-50%、T50-75%、T75-100%差异无统计学意义（P>0.05），但Tpeak、T25-50%、T50-75% C组大于A组大于B组；3组患者气管插管条件，各时点单位时间体质量顺式阿曲库铵用量差异无统计学意义（P>0.05）；C组丙泊酚用量较A、B两组显著增多且差异有统计学意义（P<0.05）。结论：右美托咪定对癫痫患者顺式阿曲库铵肌松效应无影响。

Effect of dexmedetomidine on muscle relaxant effect of cisatracurium in patients with epilepsy

AIM: To determine the effect of dexmedetomidine on muscle relaxant effect of cisatracurium in patients with epilepsy. METHODS: Sixty patients undergoing elective neurosurgery, aged from 18 to 59 years old, were divided into three groups (n=20) according to the maximum onset time of dexmedetomidine: immediate induction group after dexmedetomidine infusion (Group A), induction group 15 minutes after dexmedetomidine infusion (Group B) and normal saline infusion (Group C). The neuromuscular conduction function was monitored by muscle relaxation monitor, and the ulnar nerve was stimulated in TOF mode (frequency 2 Hz, wave width 0.2 ms, stimulation current 70 mA, string interval 12 s). Patients in group A were given dexmedetomidine 1 μg/kg after entering the room, and anesthesia induction was started immediately after 10 min pumping; Group B patients were given dexmedetomidine 1 μg/kg after entering the room, and anesthesia induction was started 15 minutes after 10 minutes of pump injection; Patients in group C began induction immediately after pumping the same milliliter of normal saline within 10 min. During anesthesia induction, 0.15 mg/kg cisatracurium was injected intravenously, and endotracheal intubation was performed when T1 reached the maximum inhibition. The modified method was used to evaluate the conditions of endotracheal intubation. When T1 recovered to 25%during the operation, cisatracurium 0.05 mg/kg was injected intravenously. The onset time (Tonset), peak time (Tpeak), 25%recovery time (T25%), 25%-50%recovery time (T25-50%), 50%-75% recovery time (T50-75%) and 75%-100%recovery time (T75-100%) of cisatracurium were recorded. Record the operation time, anesthesia time and fluid replacement volume, record the total dosage of propofol, remifentanil and cisatracurium, and calculate the dosage per unit body weight. RESULTS: There was no significant difference in Tonset, Tpeak, T25%, T25-50%, T50-75% and T75-100% among the three groups (P>0.05), but Tpeak, T25-50% and T50-75% in group C were greater than those in group A and B; There was no significant difference in tracheal intubation conditions, body weight per unit time and dosage of cisatracurium among the three groups (P>0.05); The dosage of propofol in group C was significantly higher than that in group A and B (P<0.05). CONCLUSION: Dexmedetomidine has no effect on the muscle relaxation effect of cisatracurium in patients with epilepsy.