米库氯铵与顺苯磺酸阿曲库铵在耳鼻喉科短时手术麻醉中对组胺释放的影响
张晓东 王惠铭 齐姣 尚颖 温晶
河北省保定市第二医院麻醉科,河北保定 071000
Comparison of Mivacurium and Cisatracurium on histamine release in otorhinolaryngologic short-term operation
ZHANG Xiaodong WANG Huiming QI Jiao SHANG Ying WEN Jing
Department of Anesthesiology, the Second Hospital of Baoding, Hebei Province, Baoding 071000, China
摘要 目的 定量观察和对比米库氯铵和顺苯磺酸阿曲库铵用于耳鼻喉科的短时手术中时组胺释放水平、对循环系统的影响以及相关的不良反应。 方法 选取2016年1月~2017年1月于河北省保定市第二医院行耳鼻喉短时手术治疗的患者120例,采用随机数字表法将其分为A、B两组,每组60例。分别给予米库氯铵0.2 mg/kg(A组),顺苯磺酸阿曲库铵0.15 mg/kg(B组)后插管;然后分别在静脉全身麻醉后,注射肌松药之前(T1),给予肌松药之后4 min(T2),7 min(T3)3个时间点,采集研究对象的静脉血样,使用酶联免疫吸附法测定血浆中组胺的浓度,并记录3个时间点患者的心率(HR),平均动脉压(MAP),血氧饱和度(SpO2)。观察记录两组麻醉过程中各种相关不良反应。 结果 与B组比较,A组组胺浓度明显增高(P < 0.05)。两组HR、MAP和SpO2差异无统计学意义(P > 0.05)。两组均未见组胺释放导致的严重不良反应发生。 结论 在耳鼻喉科短时手术麻醉过程中,与顺苯磺酸阿曲库铵比较,米库氯铵可导致更高水平的组胺释放,但两者严重不良反应发生情况无明显差异。
关键词 :
麻醉 ,
米库氯铵 ,
顺苯磺酸阿曲库铵 ,
组胺 ,
耳鼻喉短时手术
Abstract :Objective To quantitatively compare the effects between Mivacurium and Cisatracurium on histamine release in otorhinolaryngologic short-term operation. Methods A total of 120 short-term operation patients from January 2016 to January 2017 in the Second Hospital of Baoding were selected, and they were divided into group A and B according to the random number table method, with 60 cases in each group. The patients received Mivacurium 0.2 mg/kg (group A) and Cisatracurium 0.15 mg/kg (group B) respectively. After intravenous anesthesia, before injecting the muscle relaxant (T1) and 4 min (T2), 7 min (T3) after injecting, blood samples were collected to test plasma histamine by Elias method. Mean arterial pressure (MAP), heart rate (HR), SpO2(%) and related side-effects were recorded. Results The patients in group A had significantly increased plasma histamine compared with those in group B (P < 0.05). No statistically significant differences in HR, MAP, SpO2 and side-effects were found between the two groups (P > 0.05). Conclusion For otorhinolaryngologic short-term operations, Mivacurium caused higher plasma histamine compared with Cisatracurium, while there is no significant difference in side-effects between them.
Key words :
Anesthesia
Mivacurium
Cisatracurium
Histamine
Otorhinolaryngologic short-term operation
基金资助: 河北省保定市科技计划项目(17ZF011)。
[1] Mirakhur RK. New developments in nondepolarizing muscle relaxants [J]. Yale J Biol Med,1993,66(5):463-471.
[2] 刘洋,王守田.不同剂量米库氯铵对老年短小手术病人的肌松效果[J].中国实用乡村医生杂志,2016,23(2):54-56.
[3] 徐迎阳,高光洁,龙晓宏,等.不同效应室靶浓度异丙酚对喉显微手术患者围麻醉期米库氯铵药效学及药动学的影响[J].中国医药导报,2017,14(19):65-68.
[4] Guo JR,Zhou XF,Yuan XH,et al. Age and the neuromuscular blockading effects of Cisatracurium [J]. Int J Clin Exp Med,2015,8(9):16664-16669.
[5] Calzetta L,Soggiu A,Roncada P,et al. Propofol protects against opioid-induced hyper-responsiveness of airway smooth muscle in a horse model of target-controlled infusion anaesthesia [J]. Eur J Pharmacol,2015,76(10):546-549.
[6] Schmidt J,Irouschek A,Muenster T,et al. A priming technique accelerates onset of neuromuscular blockade at the laryngeal adductor muscles [J]. Can J Anesth,2015,52(1):50-54.
[7] 宏雨,孙前闯,董珊珊,等.米库氯铵在膀胱镜电气切术中的应用[J].中国实验诊断学,2015,19(2):304-305.
[8] 王敏,刘毅,米卫东.米库氯铵与罗库溴铵用于麻醉诱导时插管条件及安全性比较[J].重庆医学,2014,43(6):703-705.
[9] 郑方坤,程智刚.米库氯铵、顺苯磺酸阿曲库铵在腹腔镜胆囊手术中维持肌肉松弛作用的对比[J].医学综述,2015,21(22):4171-4172.
[10] 马亚利,郭庆夺,李睿,等.静脉注射顺式阿曲库铵对全麻患者的组胺释放作用[J].中华麻醉学杂志,2009,29(1):89-90.
[11] 周翔,曲彦亮,吴明春,等.异丙嗪和地塞米松预处理对全麻手术患儿米库氯铵组胺释放的影响[J].中华麻醉学杂志,2014,34(4):389-391.
[12] 杨永慧,肖海峰,孙绪德.米库氯铵在日间手术中的应用前景[J].转化医学电子杂志,2015, 2(9):139-140.
[13] 范玮璇,朱卓,潘晨宇,等.预注地塞米松预防快速推注米库氯铵引起的血流动力学波动[J].中国老年学杂志,2013,33(16):4014-4015.
[14] 钟治球,仲山,刘璐,等.米库氯铵和顺苯磺酸阿曲库铵在婴幼儿手术麻醉中对组胺释放的影响[J].安徽医药,2016,20(9):1773-1775.
[15] Shah VR,Bhosale GP,Mehta T,et al. A comparison of conventional endotracheal tube with silicone wire-reinforced tracheal tube for intubation through intubating laryngeal mask airway [J]. Saudi J Anaesth,2014,8(2):183-184.
[16] 原卓敏,贾心连,赵昌敏,等.米库氯铵用于短小手术的临床观察[J].广东医学,2016,37(s2):220-221.
[17] 鲁显福,曾因明.米库氯胺的过去、现在与未来[J].国际麻醉学与复苏杂志,2010,31(5):423-426.
[18] 杨大威,陶海勇,王欢,等.预注不同剂量米库氯铵对肌松效应的影响[J].国际麻醉学与复苏杂志,2017,38(1):22-25.
[19] 许明星,闵鑫,方立群,等.米库氯铵静脉注射与闭环靶控输注的药效学比较[J].临床麻醉学杂志,2013,29(6):529-531.
[20] Fan HX,Wang S,Zhao H,et al. Sonic hedgehog signaling may promote invasion and metastasis of oral squamous cell carcinoma by activating MMP-9 and E-cadherin expression [J]. Med Oncol,2014,31(7):41.
[21] Kammerer PW,Al-Nawas B,Kalkan S,et al. Angiogensis-related prognosis in patients with oral squamous cell carcinoma-role of the VEGF+936 C/T polymorphism [J]. J Oral Pathol Med,2015,44(6):429-436.
[22] 蓝英平,梁天北,王毅伟.米库氯铵在无抽搐电休克治疗中的应用[J].临床麻醉学杂志,2014,30(6):584-585.
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