闭环肌松注射系统结合四个成串刺激反馈用于全麻的临床观察  

Clinical investigation of closed-loop muscle relaxation injection system combined with the train-of-four(TOF)stimulation during general anesthesia

作　　者：魏栋[1] 郝润中 樊宏[1] 

机构地区：[1]北京航天总医院,100076

出　　处：《中国现代医药杂志》2013年第4期49-51,共3页Modern Medicine Journal of China

摘　　要：目的观察以四个成串刺激(TOF)为反馈信号的闭环肌松注射系统在全麻术中使用的可行性。方法 60例择期腹部手术患者,以肌松药诱导剂量分为3组,每组20例,A组(对照组)诱导剂量为顺式阿曲库铵0.15mg/kg并连接TOFwatch-SX加速度仪。B组与C组均连接闭环肌松注射系统,B组诱导剂量为顺式阿曲库铵0.15mg/kg,C组诱导剂量为0.2mg/kg。A组加药剂量0.03mg/kg。B组与C组均设定加药剂量为0.02mg·kg-1·h-1,维持剂量0.45mg·kg-1·h-1。3组都对腕部尺神经行四个成串刺激监测肌松,触发加药条件均设定为T1恢复至10%。手术结束呼吸恢复满意后拔出气管插管。记录并分析3组起效时间(T1达到最大阻滞时间)、首次触发加药时间、平均使用剂量和恢复指数(T1恢复25%～75%)。结果 B组的起效时间和首次触发时间同A组相比没有显著差异。在增加诱导剂量的前提下,C组的插管起效时间同A组相比显著缩短(P<0.05),C组的首次触发加药时间也相应延迟,同A组相比有显著延长(P<0.05)。3组在肌松药的平均使用剂量和恢复指数方面的比较均无统计学差异。结论闭环肌松注射系统可安全地用于临床,四个成串刺激可以在肌松监测中充当稳定的反馈信号。Objective To investigate the feasibility of closed-loop muscle relaxation injection system combined with train-of-four（TOF） stimulation as feedback signal in general anesthesia during the operation. Methods 60 patients undergoing elective abdominal surgery were divided into three groups（n=20 each） according to the induction dose. Group A was induced with cisatracurium O.15mg/kg before intubation and received TOF watch-SX acceleration instrument. Group B and Group C were connected to the closed-loop muscle injection system. Group B was induced with O.15mg/kg of cisatracurium and Group C 0.2mg/kg. The additional dose of Group A was 0.03 mg/kg. Group B and Group C had the same additional dose of O.02mg-kg-1 -h-l, maintenance dose of 0.45mg.kg-l-h-l. Neuromuscular blockade was evaluated with train-of-four（TOF） stimuli of the ulnar nerve at wrist in three groups and the trigger conditions were set for T1 recovery to 10%. The onset time, the first triggered time, aver age dose and recovery index （T1 25% to 75%）were recorded. Results There were no significant differences in the onset time and the first triggered time between Group A and Group B. Group C was induced with cisatracurium 0.2mg/kg and the onset time of Group C was significantly shorter than that of Group A （P〈0.05）. The first triggered time of Group C was significantly pro- longed than that of the other two groups （P〈0.05）. The average dose of muscle relaxant and recovery index were no statistically significant differences among three groups. Conclusion Closed-loop muscle relaxation injection system can be safely used in the clinic and the train-of-four（TOF） stimulation will provide a steady feedback signal during muscle relaxation monitoring.

关 键 词：闭环 四个成串刺激神经肌肉阻滞 

分 类 号：R614[医药卫生—麻醉学]