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| 富马酸氯马斯汀复合地塞米松对全麻患者米库氯铵组胺释放作用的影响 |
| Effect of clemastine fumarate and dexamethasone on histamine release induced by mivacurium in general anesthesia patients |
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| DOI：10.12089/jca.2021.03.003 |
| 中文关键词: 富马酸氯马斯汀 地塞米松 H1受体拮抗剂 米库氯铵 组胺 过敏反应 |
| 英文关键词: Clemastine fumarate Dexamethasone H1 receptor antagonist Mivacurium Histamine |
| 基金项目: |
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| 中文摘要: |
目的 观察麻醉前注射富马酸氯马斯汀复合地塞米松对全麻患者米库氯胺组胺释放的影响。
方法 选择2018年3—12月拟行全麻择期手术患者120例，男54例，女66例，年龄20～60岁，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为四组：富马酸氯马斯汀组（F组）、地塞米松组（D组）、富马酸氯马斯汀复合地塞米松组（DF组）和对照组（C组），每组30例。F组于麻醉诱导前20 min肌注富马酸氯马斯汀2 mg，D组于麻醉诱导前10 min静脉给予地塞米松磷酸钠10 mg，DF组于麻醉诱导前20 min肌注富马酸氯马斯汀2 mg，前10 min静脉给予地塞米松10 mg，C组于麻醉诱导前20 min注射等容量的生理盐水。分别于麻醉诱导前、米库氯铵给药前(给药前)、给药后1、3和5 min，采集桡动脉血样测定血浆组胺浓度，同时记录气道峰压；记录皮肤不良反应、心动过速和低血压的发生情况。
结果 与给药前比较，C组和D组给药后1和3 min后组胺浓度明显升高（P＜0.05）。与C组和D组比较，F组和DF组给药后1和3 min血浆组胺浓度明显降低（P＜0.05）。与F组比较，DF组给药后1 min血浆组胺浓度明显降低（P＜0.05）。四组气道峰压差异无统计学意义。F组、D组和DF组的皮肤不良反应的程度明显轻于C组，心动过速和低血压的发生率明显低于C组（P＜0.05）。
结论 富马酸氯马斯汀可有效抑制米库氯铵引起的组胺释放，复合地塞米松使用效果更佳，有利于维持麻醉诱导过程中血流动力学平稳。 |
| 英文摘要: |
Objective To evaluate the effects of clemastine fumarate and dexamethasone injection on histamine release induced by mivacurium in general anesthesia patients.
Methods A total of 120 patients, 54 males and 66 females, aged 20-60 years, ASA physical status Ⅰ or Ⅱ, intending to undergo general anesthesia elective operation from March to December in 2018 were selected. Patients were randomized into 4 groups (n = 30 in each group): clemastine fumarate group (group F), dexamethasone group (group D), clemastine fumarate with dexamethasone group (group DF) and control group (group C). After conventional general anesthesia induction, group F underwent injection of clemastine fumarate 2 mg 20 minutes before induction, group D was injected of dexamethasone 10 mg 10 minutes before induction, group DF was injected of clemastine fumarate 2 mg 20 minutes and dexamethasone 10 mg 10 minutes before induction, and group C was injected with equivalent normal saline. Arterial blood samples were collected immediately before anesthesia induction, before injection of mivacurium, 1, 3 and 5 minutes after injection to detect the concentration of plasma histamine. Meanwhile, peak airway pressure and local skin changes were recorded at each timing point. The incidence of tachycardia and hypotension were assessed and the use of esmolol and metaraminol were recorded.
Results Compared with the moment before mivacurium injection, histamine concentration increased significantly on 1 and 3 minutes after injection of mivacurium in groups C and D (P < 0.05). Compared with groups C and D, the plasma histamine concentration decreased 1 and 3 minutes after injection of mivacurium in groups F and DF (P < 0.05). Compared with group F, the plasma histamine concentration decreased 1 minute after mivacurium injection in group DF (P < 0.05). There was no significant difference in airway pressure among the four groups. Compared with group C, patients in the other three groups had less adverse skin reactions, the incidence of tachycardia and hypotension decreased, as well as the total use of esmolol and metaraminol (P < 0.05).
Conclusion The clemastine fumarate can effectively reduce the histamine release induced by mivacurium, and when combined with dexamethasone has a better effect, which is beneficial to maintain stable hemodynamics during anesthesia induction. |
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