顺式阿曲库铵和阿曲库铵对全麻剖宫产产妇血流动力学影响的比较

Comparative Study on Hemodynamic Effects of Cistracurium and Atracurium for Cesarean Section under General Anesthesia

关键词:  阿曲库铵，顺式阿曲库铵  剖宫产术  全身麻醉  血流动力学

Key words:  cisatracurium  atracurium  cesarean section  general anesthesia  hemodynamic

摘要:

目的 探讨顺式阿曲库铵和阿曲库铵对全麻剖宫产产妇血流动力学的影响。方法 全麻剖宫产产妇40例，ASA Ⅰ或Ⅱ级。随机均分为2组，A组和C组(n=20)。采用静脉注射丙泊酚2 mg·kg^-1和琥珀酰胆碱1.5 mg·kg^-1快诱导。气管插管后1 min，A组静注阿曲库铵0.4 mg·kg^-1，C组静注顺式阿曲库铵0.1 mg·kg^-1维持肌松。分别记录诱导前基础值(T₀)、注射非去极化肌松剂后3 min(T₁)、胎儿取出即刻(T₂)、用缩宫素后2 min(T₃)、手术结束时(T₄)的血压、心率、心输出量指数(CI)、外周血管阻力指数(SVRI)、新生儿脐动脉血气和Apgar评分等指标。结果 2组产妇术中肌松情况均满意，术后拔管时间相近。注射非去极化肌松剂后，A组血压下降、心率增快、SVRI下降，T₁、T₂和T₃时间点SBP、DBP、MAP、HR及各时间点SVRI与基础值T₀比较，差异均有统计学意义(P<0.05或P<0.01)。C组DBP与MAP在T₃时间点下降，与T₀值比较，差异有统计学意义(P<0.05)。组间比较，T₁、T₂和T₃时间点产妇SBP、DBP、MAP值A组较C组低；T₁时间点心率A组较C组快；在T₁、T₂和T₃时间点SVRI值A组较C组低，差异均有统计学意义(P<0.05或P<0.01)；组内及组间CI差异均不具有统计学意义。结论 阿曲库铵和顺式阿曲库铵用于剖宫产全麻均可提供良好的肌松条件，术后能快速恢复；与阿曲库铵比较，顺式阿曲库铵对产妇血流动力学影响更小。

Abstract:

OBJECTIVE To investigate effects of cisatracurium and atracurium on hemodynamic in cesarean section under general anesthesia. METHODS A total of 40 puerpera acceptance cesarean section under general anesthesia, ASA Ⅰ-Ⅱ grade, were randomly divided into two groups: group A and group C(n=20 respectively). Rapid sequence intubation was accomplished by intravenous propofol 2 mg·kg^-1 and succinylcholine 1.5 mg·kg^-1. Maintenance of muscle relaxation was achieved through intravenous atracurium 0.4 mg·kg^-1(group A), or intravenous cisatracurium 0.1 mg·kg^-1(group C). Blood pressure, heart rate(HR) and cardiac output index (CI), systemic vascular resistance index (SVRI), neonatal Apgar scores and umbilical arterial blood gas and other parameter were recorded at baseline values before induction(T₀), 3 min after injected of non-depolarizing muscle relaxant (T₁), the fetus removed immediately(T₂), 2 min after using oxytocin(T₃), the end of surgery(T₄), respectively. RESULTS Two groups of maternal intraoperative muscle relaxants were satisfied, with similar postoperative extubation time. After injection of non-depolarizing muscle relaxants, the blood pressure drop, the HR increased and SVRI declined in group A. Compared with the base value T₀, the differences of the SBP, DBP, MAP, HR at T₁, T₂ and T₃ and SVRI at T₁, T₂, T₃, T₄ were statistically significant(P<0.05 or P<0.01) in group A. Compared with the base value T₀, the difference of the DBP and MAP decreased at T₃ was statistically significant(P<0.05) in group C. The SBP, DBP, MAP values in group A was lower at T₁, T₂ and T₃ time points than in group C. The HR was faster in group A at T₁ than in group C; SVRI values of group A at T₁, T₂ and T₃ time points was lower than that in group C and the difference were statistically significant(P<0.05 or P<0.01). CI between the two groups and within the group had no significant difference(P>0.05). CONCLUSION General anesthesia for cesarean section using atracurium or cisatracurium can provide excellent muscle relaxant conditions, and can quickly recover after surgery. Comparing with atracurium, cisatracurium shows a smaller maternal hemodynamic change.