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Objective To observe isoflurane inhalation anesthesia atracurium single intravenous injection of muscle relaxant effects of continuous intravenous infusion and target-controlled infusion of three different modes of administration, to provide a reference for clinical. Method elective anesthesia downlink gynecological abdominal surgery, 45 patients, ASA Ⅰ - Ⅱ grade, were randomly divided into atracurium intermittent intravenous group (IBI), the continuous infusion group (CI) and target-controlled infusion group (TCI) 15 cases each, all patients with heart, lung, liver, kidney function normal, no neuromuscular conduction dysfunction disease history, anhydrous electrolyte imbalance and acid-base balance, not taking preoperative of any influential neuromuscular blocking drugs function. The operative time was longer than 2 hours. Intravenous midazolam 0.05mg/Kg, the fentanyl 4ug/Kg, propofol 4ug/ml target-controlled infusion induction of anesthesia, after induction of anesthesia in patients with sleep, the first automatic calibration CAL key, single twitch height 5min after the start of four clusters stimulate stable at 100%, TCI Group Marathe pharmacokinetic parameters model target effect concentration 2ug/ml induced the IBI and CI groups were single intravenous injection 0.6mg/Kg atracurium ammonium. Less than 5% or 0:00 when T 1 decreased to the control value or the maximum block by mouth photopic endotracheal intubation. The set T 1 = 10% for the the target muscle relaxants depth, T 1 recovery to 10%, TCI group with immediate effect compartment concentration increments 0.1ug/ml regulation atracurium the TCI; CI group to the initial rate 12ug/Kg/min continuous infusion every 5min infusion rate changes in the magnitude of 10% -20% (if you can not maintain the target depth of muscle relaxants, the appropriate rate of increase) ; the IBI group of single dose administered at intervals of time ago T 1 recovered to 10% for standard each dose 0.2mg/Kg. Continuous inhalation of isoflurane to maintain end-tidal isoflurane concentration - adapted 1 minimum alveolar concentration (MAC), remifentanil 2-5ng/mlTCI maintain anesthesia. Surgery completed before 20min, TCI group and CI group stopping the infusion of atracurium the IBI group is no longer chasing the the Qaa song library ammonium, and at the same time stop isoflurane inhalation, increase the flow of oxygen to 81/min of hyperventilation row ether . The three groups of patients with muscle recovery all do not neostigmine antagonistic. The surgery record: induction dosage of atracurium onset time, clinical duration of action and recovery time, recovery index, evaluation of intubation conditions, record TCI group and CI group began TCI and continuous infusion of 0, 15, 30, 60 the IBI group, 90 and 120min effect compartment concentration and continuous infusion rate, record each chase the Qaa music library ammonium interval. Results TCI and CI group during surgery stable level of muscle relaxants, the IBI group the muscle relaxants levels throughout the procedure volatile. The TCI group atracurium induced amount is less than the CI and the IBI group (P <0.05), TCI group onset time is longer than the CI and the IBI group (P <0.05), CI and IBI Group neuromuscular block was reached T 1 = 5% or 0 the TCI Group neuromuscular blockade degree of 86% ± 13%; CI group and the the IBI group of intubating conditions better than the TCI group Krieg modified method of rating were: TCI group was 6.9 ± 1.3, CI group 8.8 ± 0.6, IBI group was 8.6 ± 0.7; of TCI clinical duration of action is shorter than the CI and the IBI group were 32.1 ± 8.1,40.8 ± 8.7,39.7 ± 7.5min. The infusion rate of TCI and CI group showed a downward trend, both in 30min after infusion took the steady-state infusion rate the TCI group target effect concentration of approximately 1.0 ± 0.18ug/ml the CI group infusion rate was 5.2 ± 1.01ug / Kg / min. IBI patients administered time interval for 24-45min, an average of 32 ± 5 min. Recovery time the TCI and CI group similar, but shorter than the IBI group, no significant difference between the three groups atracurium recovery index group. Conclusion 1 atracurium TCI effect compartment to concentration 2ug/ml inappropriate induction of anesthesia. 2 in neuromuscular monitoring under the guidance, the the TCI group CI group could maintain the target for the depth of the muscle relaxant, muscle relaxant effect is stable, and the TCI group regulation was significantly less than the number of the CI group, and therefore more competitive. After stopping the infusion, TCI and CI group representing the IBI group recovered faster. 3 TCI CI more suitable for maintenance of anesthesia.
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