麻醉恢复室内残余肌肉松弛作用与严重Ⅱ乎吸系统并发症的关系  

作　　者：Glenn S. Murphy Joseph W. Szokol Jesse H. Marymont Steven B. Greenberg Michael J. Avram Jeffery S. Vender 邹蓉(译) 崔苏扬(校) 

机构地区：[1]Department of Anesthesiology, Evanston Northwestern Healthcare, Evanston, Illinois [2]不详

出　　处：《麻醉与镇痛》2009年第4期23-30,共8页Anesthesia & Analgesia

摘　　要：背景麻醉恢复室内（PACU）患者肌肉松弛作用恢复不全可能影响其肺和上呼吸道的功能，导致呼吸系统并发症。本研究旨在评估和定量分析PACU内发生严重呼吸系统并发症（CREs）患者残余肌肉松弛作用的严重程度。方法资料收集持续1年。根据事先定义的CRE，PACU的护士在患者入室15分钟内评估是否存在CRE。应用肌肉加速度描记图评估这些患者的4个成串刺激（train of four，TOF）值（病例组）。同时记录对照组的TOF值，对照组亦为全身麻醉，且其年龄、性别以及手术过程与病例组配对。结果1年内有7459例患者接受全身麻醉，61例发生CRE。其中42例有与其配对的对照组，且能进行统计学分析。最常见的CRE是严重低氧血症（22例，52．4％）以及上呼吸道梗阻（15例，35．7％）。病例组与对照组间手术前或手术中数据没有显著差异。病例组平均TOF值（±SD）是0．62（±0．20），73．8％的病例TOF值〈0．70。相反，对照组平均TOF值（±SD）是0．98（±0．07）（差值-0．36，95％可信区间是-0．43=0．30，P〈0．0001），并且没有患者TOF值〈0．70（95％可信区间是59％-85％，P〈0．0001）。结论与对照组相比，在CREs患者中严重的残余肌肉松弛作用的影响很大。研究结果提示，肌肉松弛作用恢复不全是PACU患者发生呼吸系统并发症的重要影响因素。BACKGROUND： Incomplete recovery of neuromuscular function may impair pulmonary and upper airway function and contribute to adverse respiratory events in the postanesthesia care unit （PACU）. The aim of this investigation was to assess and quantify the severity of neuromuscular blockade in patients with signs or symptoms of critical respiratory events （CREs） in the PACU. METHODS： We collected data over a 1-yr period. PACU nurses identified patients with evidence of a predefined CRE during the first 15 rain of PACU admission. Train-of-four （TOF） ratios were immediately quantified in these patients using acceleromyography （cases）. TOF data were also collected in a control group that consisted of patients undergoing a general anesthetic during the same period who were matched with the cases by age, sex, and surgical procedure. RESULTS： A total of 7459 pa- tients received a general anesthetic during the 1-yr period, of whom 61 developed a CRE. Forty-two of these cases were matched with controls and constituted the study group for statistical analysis. The most common CREs among matched cases were severe hypoxemia （22 of 42 patients; 52.4% ） and upper airway obstruction （15 of 42 patients; 35.7%）, There were no significant differences between the cases and matched controls in any measured preoperative or intraoperative variables. Mean （±SD） TOF ratios were 0. 62 （ ±0. 20） in the cases, with 73.8% of the cases having TOF ratios 〈 0.70. In contrast, TOF values in the controls were 0.98 （±0.07） （a difference of -0.36 with a 95% confidence interval of - 0. 43 to - 0. 30, P 〈 0. 0001 ）, and no control patients were observed to have TOF values 〈 0. 70 （the 95% confidence interval of the difference was 59% - 85%, P 〈 0. 0001 ）. CONCLUSIONS： A high incidence of severe residual blockade was observed in patients with CREs, which was absent in control patients without CREs. These findings suggest that incomplete neuromuscular recovery is an important contributing fact

关 键 词：呼吸系统并发症 肌肉松弛作用 麻醉恢复 残余 室内 上呼吸道梗阻 PACU 严重低氧血症 

分 类 号：R734.205[医药卫生—肿瘤] R971.2[医药卫生—临床医学]