• 作者： 李清木; 關榮輝; 陳炳肇; 蔡勝國
• 作者服務機構： 美國加州大學醫學院海港中心麻醉部; 榮總麻醉部暨陽明醫學院麻醉學系
• 中文摘要： 本研究是以一種長效且不會產生心律變快的非去極化神經肌肉阻斷劑pipecuronium應用於20位剖腹產手術麻醉來研究手術中維持神經肌肉阻斷所需的適當劑量以及對於胎盤穿透和新生兒的影響。結果顯示pipecuronium幾乎對於產婦的臟血管作用和胎盤的穿透力沒有影響。同時對於新生兒無抑制的作用。給予靜脈注射0.035mg kg 和0.05mg kg 的維持劑量皆可在手術中產生良好的肌肉鬆弛作用。兩者在發生神經肌肉阻斷所需的時間相似（3.1±0.3對3.8±0.6分，p=0.25）但後者在維持阻斷的時間顯然地較前者長（13.1±1.8對39.3±6.9，p＜0.05）。兩者在25％神經肌肉恢復時皆可有效的使用edrophonium 0.5mg kg或neostigmine 0.04mg kg達到拮抗的作用。因此我們的結論是pipecuronium在剖腹產麻醉中，使用低於0.035mg kg的劑量即可產生安全而且有效的神經肌肉阻斷和恢復的作用。
• 英文摘要： We studied the suitability of pipecuronium for maintenance of neuromuscular block during 20 electiveCaesarean sections under light general anaesthesia with a rapid-sequence technique facilitated by i.v. sux-amethonium 0.6-0.8 mg. An initial dose of 0.035 mg or 0.05 mg of pipecuronium providedsatisfactory relaxation of similar speed of onset (3.1 ± 0.3 vs 3.8 ± 0.6 min, p=0.25); however the higherdose had a significantly longer duration of action than the lower dose (from injection to recovery to 20%of baseline 13.1 ± 1.8 vs 39.3 ± 6.9 min, p<0.05). A spontaneous recovery of the T1 twitch of the train-of-four to 25% of baseline (residual block 75%) assured rapid antagonism of the residual block with eitheredrophonium 0.5 mg or neostigmine 0.04 mg. A residual block greater than 80% depression ofT1 markedly prolonged the time taken to achieve a satisfactory reversal. Pipecuronium had negligiblecardiovascular effects and placental transfer. It had no observable effect on the newborn. In spite of someadvantages, we conclude that pipecuronium is a suitable alternative during Caesarean section only whenused judiciously in small doses for maintenance of neuromuscular block and recommend that the initialdose be no greater than 0.035 mg.
• 中文關鍵字： Pipecuronium (in Caesarean section; placental transfer); nondepolarizing neuromuscular relaxant (pipecuronium); obstetric anesthesia (pipecuronium).
• 英文關鍵字： --