镁对罗库溴铵肌松作用的影响

罗库溴铵是临床常用的肌松药，其效果受到诸多因素的影响，对这些影响因素的深入研究有助于提高临床麻醉安全性，这篇发表在Eur J Anaesthesiol杂志上的文章Effects of magnesium on the dose of rocuronium for deep neuromuscular blockade: A randomised controlled trial阐述了镁对罗库溴铵肌松剂量的影响。

镁对罗库溴铵深度神经肌肉阻滞剂量的影响：一项随机对照试验

背景：众所周知，镁能增强罗库溴铵的作用，但其程度尚未量化。

目的：探讨镁对罗库溴铵深度神经肌肉阻滞剂量的影响。

设计：随机对照研究。

单位：一家三级医院。

患者：70名计划接受机器人辅助腹腔镜前列腺切除术、年龄在20～80岁之间的男性患者，ASA分级为1级或2级。

干预措施：患者随机分为镁组和对照组。镁组注射镁50mg/kg，术中连续输注15mg/kg/h，对照组注入等量的0.9%生理盐水。通过持续输注罗库溴铵维持深度神经肌肉阻滞，并用苏加明（sugammadex）逆转。

主要观察指标：主要观察指标为罗库溴铵维持深度神经肌肉阻滞的剂量。次要结果是恢复时间，定义为从给予苏加明到TOF的时间比值达到0.9，以及术后恶心呕吐的发生率。

结果：镁组维持深度神经肌肉阻滞的罗库溴铵剂量明显低于对照组（7.5μg/kg/min VS 9.4μg/kg/min，P=0.01）。两组在恢复时间和恶心呕吐发生率上无差异。

结论：镁可使深度神经肌肉阻滞所需罗库溴铵的剂量减少约20%，而不影响其恢复时间。

Effects of magnesium on the dose of rocuronium for deep neuromuscular blockade: A randomised controlled trial

Background: Magnesium is known to enhance the effect of rocuronium, but the extent is not quantified.

Objectives: We aimed to quantify the effect of magnesium on the dose of rocuronium for deep neuromuscular blockade.

Design: A randomised controlled study.

Setting: A single tertiary care hospital.

Patients: Seventy males scheduled to undergo robot-assisted laparoscopic prostatectomy, aged between 20 and 80 years with American Society of Anesthesiologists physical status classification 1 or 2, were enrolled.

Interventions: Patients were randomised to either the magnesium group or control group. The magnesium group were infused with 50 mg kg of magnesium, followed by a continuous intra-operative infusion at 15 mg kg h while the control group were infused with the same volumes of 0.9% saline. Deep neuromuscular blockade was maintained with a continuous infusion of rocuronium and was reversed using sugammadex.

Main outcome measures: The primary outcome was the dose of rocuronium administered to maintain deep neuromuscular blockade. The secondary outcomes were recovery time, defined as the time from the administration of sugammadex to train-of-four ratio 0.9, and the incidence of postoperative nausea and vomiting.

Results: The dose of rocuronium administered to maintain deep neuromuscular blockade was significantly lower in the magnesium group (7.5 vs. 9.4 μg kg min, P = 0.01). There was no difference in recovery time or the incidence of nausea and vomiting.

Conclusion: Magnesium reduced the dose of rocuronium required for deep neuromuscular blockade by approximately 20% without affecting the recovery time after administration of sugammadex.

Trial registration: ClinicalTrials.gov identifier: NCT04013243.

Han J, Jeon YT, Ryu JH, et al. Effects of magnesium on the dose of rocuronium for deep neuromuscular blockade: A randomised controlled trial [published online ahead of print, 2020 Sep 2]. Eur J Anaesthesiol. 2020;10.1097/EJA.0000000000001329. doi:10.1097/EJA.0000000000001329