Continuous Infusion versus Intermittent Bolus Dosing of Vecuronium in Patients Receiving Therapeutic Hypothermia After Sudden Cardiac Arrest
Continuous Infusion versus Intermittent Bolus Dosing of Vecuronium in Patients Receiving Therapeutic Hypothermia After Sudden Cardiac Arrest
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DOI：
10.1592/phco.31.12.1250
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发表时间：
2011-12-01
期刊：
影响因子：
4.1
通讯作者：
Gulbis, Brian E.
中科院分区：
文献类型：
--
作者：
Jurado, Lesly V.;Gulbis, Brian E.
研究目的。比较静脉持续输注维库溴铵与间断推注维库溴铵在心脏骤停（SCA）后接受治疗性低温治疗的患者中的效果。回顾性病历审查。设置。一所大学附属的一级创伤中心的心脏监护室。在123例SCA后接受低温治疗的成人中，80例在降温开始后2小时或发生寒战时开始持续输注维库溴铵0.8 μ g/kg/min（2004年1月1日至2007年12月31日），43例患者接受维库溴铵0.05 mg/kg间歇推注，每2小时一次（2008年1月1日，2009年9月30日）。测量和主要结果。神经肌肉阻滞的程度用四联训练（TOF）试验测量。评价的主要结局是达到目标TOF反应的时间和TOF反应维持在目标的时间百分比。次要结果包括维库溴铵的每日总剂量、达到目标TOF反应所需的维库溴铵剂量、TOF测量值高于或低于目标的百分比、自主呼吸恢复时间和末次维库溴铵给药后拔管时间。推注组比连续输注组更早达到目标TOF反应（平均5.9 vs 11.3小时，p=0.008）。推注组维库溴铵的平均日总剂量显著低于持续输注组（51.7 vs 76.9 mg，p=0.002）。持续输注组TOF测量值高于目标值的平均百分比较高（33% vs 16%，p
Study Objective. To compare the effects of vecuronium administered as an intravenous continuous infusion versus intermittent bolus doses in patients treated with therapeutic hypothermia after sudden cardiac arrest (SCA).Design. Retrospective medical record review.Setting. Cardiac care unit of a university-affiliated, level I trauma center.Patients. Of 123 adults treated with therapeutic hypothermia after SCA, 80 received continuous-infusion vecuronium 0.8 mu g/kg/minute started 2 hours after cooling began or if shivering occurred (January 1, 2004 December 31, 2007), and 43 received intermittent boluses of vecuronium 0.05 mg/kg every 2 hours (January 1, 2008 September 30, 2009).Measurements and Main Results. The degree of neuromuscular blockade was measured with a train-of-four (TOF) test. Primary outcomes evaluated were time to achieve goal TOF response and percentage of time the TOF response was maintained at goal. Secondary outcomes included total daily dose of vecuronium, the vecuronium dose needed to achieve goal TOF response, percentage of TOF measurements above or below goal, and time to return of spontaneous respirations and time to extubation after the last dose of vecuronium. The goal TOF response was achieved significantly earlier in the bolus group than the continuous-infusion group (mean 5.9 vs 11.3 hrs, p=0.008). The mean total daily dose of vecuronium administered in the bolus group was significantly lower than that in the continuous-infusion group (51.7 vs 76.9 mg, p=0.002). The mean percentage of TOF measurements above goal was higher in the continuous-infusion group (33% vs 16%, p