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Effects of Rocuronium on Myocardial Oxygen SupplyDemand in Patients with Rheumatic Heart Disease during Induction of Anaesthesia

摘要:目的: 在風濕性心臟病患者瓣膜置換術中,評價羅庫溴銨在麻醉誘導期間對患者心肌氧供和氧耗平衡的影響。 方法 :選擇86例在中低溫體循環下行瓣膜置換術的患者,采用隨機雙盲法分配成羅庫溴銨組(n=42例)和維庫溴銨組(n=41例)。給予咪唑安定(005～01 mg/kg)及芬太尼(10～15μg/kg)及等效劑量的羅庫溴銨06 mg/kg或維庫溴銨01 mg/kg(Org. Comp)進行麻醉誘導。監測麻醉誘導前至插管后10分鐘(1次/1分)期間兩組患者心肌氧供和氧耗的變化。 結果 :與基礎值相比,羅庫溴銨組患者在插管后5分鐘期間心率增加了174%～135%,動脈收縮壓增加了1694%～143%,平均動脈壓增加了151%～132%。同期心率收縮壓乘積增加了2267%～1396% (〖WTBX〗P lt;005)。心率和動脈血壓在插管后1～7分鐘期間明顯高于同期的維庫溴銨組患者(〖WTBX〗P lt;005)。 結論 :在ASA ⅢⅣ級、心功ⅡⅢ級風心病瓣膜病變患者進行瓣膜置換術中, 06 mg/kg羅庫溴銨有潛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).