首都医科大学学报 ›› 2003, Vol. 24 ›› Issue (1): 67-70.

• 论著·临床研究 • 上一篇    下一篇

新斯的明和阿托品用于肌松拮抗时对血流动力学的影响

李艳, 周晓莉, 王保国   

  1. 首都医科大学附属北京大坛医院麻醉科
  • 收稿日期:2002-01-10 修回日期:1900-01-01 出版日期:2003-01-15 发布日期:2003-01-15

Hemodynamic Effects of Neostigmine and Atropine used for Reversing Muscular Relaxation

Li Yan, Zhou Xiaoli, Wang Baoguo   

  1. Department of Anesthesiology, Beijing Tiantan Hospital, Affiliate of Capital University of Medical Sciences
  • Received:2002-01-10 Revised:1900-01-01 Online:2003-01-15 Published:2003-01-15

摘要: 为观察全麻术后应用新斯的明和阿托品进行肌肉松弛(以下简称肌松)拮抗对血流动力学的影响,将21例术中持续吸入异氟醚维持麻醉、间断静脉注射哌库溴铵维持肌松的择期颅脑手术患者(ASAⅠ~Ⅱ级),术后随机分组,静脉注射不同剂量新斯的明和阿托品(Ⅰ组新斯的明0.05mg/kg、阿托品0.025mg/kg;Ⅱ组新斯的明0.05mg/kg、阿托品0.017mg/kg),拮抗肌松残余作用。用DATEX多功能监测仪和HEMOSONICTM100经食管超声多普勒仪连续监测给药前后血流动力学各参数的变化。结果:2组病人给药后1、2、3min心率都明显增快,Ⅱ组给药后30min心率和峰值血流速度(PV)明显降低,其他血流动力学参数给药前后均无明显变化。提示:0.05mg/kg新斯的明配伍0.017mg/kg阿托品进行肌松拮抗时易引起延迟性心动过缓,且抑制心肌收缩力;对于无器质性心脏病、无心肌缺血的病人,0.05mg/kg新斯的明和0.025mg/kg阿托品为较好的配伍。

关键词: 新斯的明, 阿托品, 血流动力学, 经食管超声多普勒

Abstract: The objective was to observe the hemodynamic changes after intravenous injection of neostigmine and atropine used for reversing the muscular relaxation. Methods: Twenty one neurosurgical patients, ASA class Ⅰ~Ⅱ, were randomly allocated into two groups. The mixture of neostigmine and atropine with 2∶1 (0.05 mg/kg∶0.025 mg/kg) in group Ⅰ or 3∶1 (0.05 mg/kg∶0.017 mg/kg) in group Ⅱ was given intravenously at the end of surgery with isoflurane pipecuronium anesthesia. The hemodynamic parameters were measured with transesophageal Doppler monitor (HEMOSONICTM 100) and Datex Cardiocap. Result: In both groups, HR increased significantly at 1, 2, 3 min after injecting the mixture of neostigmine and atropine. HR and peak velocity (PV) decreased significantly at 30 min after injection in group II. Other hemodynamic parameters did not change significantly after neostigmine and atropine were administered intravenously. Conclusion: 0.05 mg/kg neostigmine and 0.025 mg/kg atropine appear to be a better combination used for the neuromuscular reversal.

Key words: neostigmine, atropine, hemodynamics, transesophageal doppler

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