无肌松维持全麻用于经皮肾镜碎石术的安全性和有效性  

Maintenance of general anesthesia without muscle relaxant for percutaneous nephrolithotomy

作　　者：杨戈雄[1] 袁杰[2] 毛兰萍[1] 马军令[1] 袁超英[2] 高爽[1] 

机构地区：[1]武警新疆总队医院麻醉科,新疆乌鲁木齐830091 [2]武警新疆总队医院泌尿外科,新疆乌鲁木齐830091

出　　处：《武警医学院学报》2012年第4期253-255,共3页Acta Academiae Medicinae CPAPF

摘　　要：【目的】探讨无肌松维持全凭静脉麻醉用于经皮肾镜碎石术的安全性和有效性。【方法】将180例择期行经皮肾镜碎石术的患者随机分成插管后肌松维持组(I组)及插管后无肌松维持组(II组)各90例。I组予维库溴铵0.08～0.1mg/kg诱导、在患者有体动时或每40 min静注0.05 mg/kg维持肌松;II组予维库溴铵0.05 mg/kg诱导插管,术中无肌松维持。记录两组麻醉前、气管插管前、气管插管后、手术开始后20 min、拔管前、术后1 h各时点血压、心率、sPO2等血流动力学指标并与基础值比较。并记录各组术毕恢复情况。【结果】各组气管插管均一次成功,术中麻醉平稳,无体动反应,均顺利完成手术。无肌松维持组术后苏醒各项指标显著短于对照组。术后意识完全清醒,无须拮抗肌松,无呼吸抑制及呕吐误吸、分泌物阻塞、呼吸道梗阻发生。【结论】无肌松维持下丙泊酚-瑞芬太尼全凭静脉麻醉可满足经皮肾镜碎石术的需要,降低麻醉风险。【Objective】To investigate the safety and effectiveness of percutaneous nephrolithotomy without muscle relaxants to maintain total intravenous anesthesia.【Methods】A total of 180 patients undergoing percutaneous nephrolithotomy were randomly divided into muscle relaxants intubation maintenance group（group I induced 90 cases） and intubation without muscle relaxants maintain group（group II,90 cases）.Group I induced with vecuronium 0.08 ~ 0.1mg/kg,when patients moved or ever 40 min 0.05 mg/kg maintain muscle relaxation were given.Group II inducted with vecuronium bromide（0.05 mg/kg） and tracheal intubated but without muscle relaxants maintenance during operation.Blood pressure,heart rate,sPO2 and other hemodynamic parameters of two groups were recorded before anesthesia,before tracheal intubation and after tracheal intubation,20 min after surgery,before extubation and 1h after operation,compared with basic value.Postoperative recovery were recorded.【results】Each endotracheal intubation was successful,anesthesia was smooth during operation,there was no body movement responses,operation were successfully completed.Without muscle relaxants maintain group recovery indicators significantly shorter than the control group.Patient were fully conscious after operation,with no need for antagonistic muscle relaxants,without vomiting and secretions obstruction,without respiratory depression and airway obstruction occurred.【Conclusion】Without muscle relaxants to maintain total intravenous anesthesia of propofol-remifentanil can meet the need of percutaneous nephrolithotomy and reduce the risk of anesthesia.

关 键 词：全身麻醉 丙泊酚 瑞芬太尼 经皮肾镜碎石术 

分 类 号：R193[医药卫生—卫生事业管理]