摘要:目的: 在风湿性心脏病患者瓣膜置换术中,评价罗库溴铵在麻醉诱导期间对患者心肌氧供和氧耗平衡的影响。 方法 :选择86例在中低温体循环下行瓣膜置换术的患者,采用随机双盲法分配成罗库溴铵组(n=42例)和维库溴铵组(n=41例)。给予咪唑安定(005～01 mg/kg)及芬太尼(10～15μg/kg)及等效剂量的罗库溴铵06 mg/kg或维库溴铵01 mg/kg(Org. Comp)进行麻醉诱导。监测麻醉诱导前至插管后10分钟(1次/1分)期间两组患者心肌氧供和氧耗的变化。 结果 :与基础值相比,罗库溴铵组患者在插管后5分钟期间心率增加了174%～135%,动脉收缩压增加了1694%～143%,平均动脉压增加了151%～132%。同期心率收缩压乘积增加了2267%～1396% (〖WTBX〗P  lt;005)。心率和动脉血压在插管后1～7分钟期间明显高于同期的维库溴铵组患者(〖WTBX〗P  lt;005)。 结论 :在ASA ⅢⅣ级、心功ⅡⅢ级风心病瓣膜病变患者进行瓣膜置换术中, 06 mg/kg罗库溴铵有潜在增加患者心肌耗氧量的作用。
Abstract: Objective: To evaluate the effects of rocuronium on myocardial oxygen supplydemand in patients with rheumatic heart disease (RHD) during induction. Methods : 86 patients of either sex (ASA status ⅢⅣ; New York Heart Association classes ⅡⅢ) scheduled for valve replacement surgery were included in this randomized clinical trial (RCT). SwanGanz catheter was placed via right internal jugular vein before the induction of anaesthesia. Anaesthesia was induced with midazolam 00501mg.kg-1 and fentanyl 1015 μg·kg-1. The patients were randomized to receive either rocuronium 06 mg·kg-1 (group R, 〖WTBX〗n= 42) or vecuronium 01 mg·kg-1 (group V, 〖WTBX〗n= 41) to facilitate tracheal intubation when bispectral index (BIS) value dropped to 60 All data were recorded at the time before anaesthesia (Tb), loss of consciousness (Ts), administration of muscle relaxant (Tm), 1 min after administration of muscle relaxant (T1), when trainoffour stimulation (TOF) reached 0 (T2) and 1,2,3,4,5,7,10 min after tracheal intubation (T39).〖WTHZ〗Results : Heart rate (HR) increased by 174%135%, systemic arterial systolic pressure (SAP) increased by 1694%143%, mean arterial systolic pressure (MAP) increased by 151%132% and product of heart rate and arterial systolic pressure(RPP) increased 2267%1396% respectively during 5 minutes after intubation as compared with baseline in group R, which were significantly higher than those in group V during 5 minutes after intubation (〖WTBX〗P  lt;005). Conclusion : An intubation dose of rocuronium should be used cautiously in patients with rheumatic heart disease (ASA status ⅢⅣ; NYHA classes IIⅢ).

Citation： CHEN Guo,LI Yu,LI Qian,LIU Bin,et al.. Effects of Rocuronium on Myocardial Oxygen SupplyDemand in Patients with Rheumatic Heart Disease during Induction of Anaesthesia. West China Medical Journal, 2009, 24(10): 2593-. doi: Copy