米库氯铵在老年患者气管插管中的应用及其对心率和平均动脉压的影响

Application of mivacurium chloride in tracheal intubation for elderly patients and its effect on patients′ heart rate and mean arterial pressure

摘要:

目的 探讨米库氯铵在老年患者气管插管中的应用及其对心率(HR)和平均动脉压(MAP)的影响。方法 选取2016年8月至2018年8月西安交通大学第二附属医院收治的老年患者60例为研究对象。随机数表法分为2组:米库氯铵组和阿曲库铵组,每组30例。比较2组患者的肌松药起效时间和静脉注射肌松药到4个成串刺激(TOF)恢复25%时间。比较麻醉前(T0)、静脉注射肌松药后1min(T1)、静脉注射肌松药后2min(T2)、插管前即刻(T3)、插管后即刻(T4)时2组患者的HR、MAP、脑电双频谱指数(BIS)、血清去甲肾上腺素(NE)和组胺(HIS)。采用SPSS 21.0软件进行数据处理。结果 米库氯铵组患者的肌松药起效时间[(211.3±32.5) vs(383.5±34.5)s]、静脉注射肌松药到TOF恢复25%时间[(23.5±4.5) vs(40.4±6.4)min]均显著短于阿曲库铵组(P<0.05)。T4时米库氯铵组患者的HR[(84.3±13.8) vs(94.5±15.4)次/min]、MAP[(94.3±13.8) vs(104.7±9.2)mmHg(1mmHg=0.133kPa)]、BIS[(55.7±6.8) vs(60.2±7.0)]和NE浓度[(654.7±165.3) vs(766.0±100.0)ng/ml]均显著低于阿曲库铵组(P<0.05)。T1[(1.31±0.17) vs(0.56±0.05)ng/ml]、T2[(1.04±0.15) vs(0.55±0.03)ng/ml]、T3[(0.79±0.09) vs(0.54±0.03)ng/ml]、T4[(0.67±0.08) vs(0.56±0.04)ng/ml]时米库氯铵组患者的血清HIS浓度均显著高于阿曲库铵组(P<0.05)。结论 与顺苯磺酸阿曲库铵相比,米库氯铵在老年患者气管插管中的应用效果更好,更能有效保持患者HR和MAP稳定。

Abstract:

Objective To investigate the application of mivacurium chloride in tracheal intubation for the elderly patients and its effect on patients′ heart rate (HR) and mean arterial pressure (MAP). Methods A total of 60 elderly patients admitted in our hospital from August 2016 to August 2018 were recruited prospectively, and then randomly divided into mivacurium chloride group (n=30) and atracurium group (n=30). The onset time of muscle relaxant, and 25% recovery time from intravenous injection of muscle relaxant to train of four stimulation (TOF), and HR, MAP, bispectral index of electroencephalogram (BIS), serum levels of norepinephrine (NE) and histamine (HIS) before anesthesia (T0), 1min (T1) and 2min (T2) after intravenous injection of muscle relaxant, immediately before intubation (T3) and immediately after intubation (T4) were compared between the 2 groups. SPSS statistics 21.0 was used to perform the statistical analysis. Results The onset time of muscle relaxants [(211.3±32.5) vs (383.5±34.5)s] and recovery time from intravenous injection of muscle relaxants to 25% of TOF [(23.5±4.5) vs (40.4±6.4)min] were significantly shorter in the mivacurium chloride group than in the atracurium group (P<0.05). At T4, the patients of the mivacurium chloride group had statistically lower HR [(84.3±13.8) vs (94.5±15.4)beats/min], MAP [(94.3±13.8) vs (104.7±9.2)mmHg(1mmHg=0.133kPa)], BIS [(55.7±6.8) vs (60.2±7.0)] and NE level [(654.7±165.3) vs (766.0±100.0)ng/ml] when compared with those from the atracurium group (P<0.05). What′s more, the serum HIS levels of the mivacurium chloride group were notably higher than those of atracurium group (P<0.05) at T1 [(1.31±0.17) vs (0.56±0.05)ng/ml], T2 [(1.04±0.15) vs (0.55±0.03)ng/ml], T3 [(0.79±0.09) vs (0.54±.03)ng/ml], and T4[(0.67±0.08) vs (0.56±0.04)ng/ml]. Conclusion Mivacurium chloride is better than atracurium cis-besylate in the application of tracheal intubation in elderly patients, and can maintain the stability of HR and MAP of patients more effectively.