后腹腔镜手术中顺式阿曲库铵肌松效应的观察  

Muscle relaxation in retroperitoneal laparoscopic surgery guided by CLMRIS-1

作　　者：阎雁宏[1] 薛纪秀[1] 马艳辉[1] 尹橙[1] 李冰[1] 

机构地区：[1]首都医科大学宣武医院麻醉科,北京100053

出　　处：《北京医学》2014年第2期122-125,共4页Beijing Medical Journal

基　　金：北京市科技计划课题(Z121107001012160)

摘　　要：目的 在闭环输注系统（CLMRIS-1）指导下研究后腹腔镜手术与非腹腔镜手术顺式阿曲库铵肌松效应的差异.方法 选择30例ASA Ⅰ ～Ⅲ级的择期手术患者,依据手术方式,分为后腹腔镜手术组（R组）和非腹腔镜手术组（C组）,每组15例.麻醉诱导均采用依托咪酯,芬太尼,顺式阿曲库铵；麻醉维持采用丙泊酚,瑞芬太尼持续输注,顺式阿曲库铵的输注应用CLMRIS-1闭环输注系统.记录两组患者肌松药的起效时间T0（首次注射顺式阿曲库铵至T1抑制到0的时间）,恢复指数RI（T1从25％恢复至75％的时间）,停药至T1恢复至95％的时间（T95）,停药至TOF恢复到75％的时间（TOFr75）,手术持续时间,以及肌松药的消耗量；于患者术前及停止肌松输注即刻分别抽取动脉血样进行血气分析；记录拔管后发生呼吸功能不全的例数;术后24h内发生呼吸不良的例数.结果 R组和C组肌松药的用量分别为（1.2±0.3）μg/（kg·min）和（1.8±0.6）μg/（kg· min）,两组比较差异有统计学意义（P＜0.05）；两组患者的RI分别为（17.10±5.25）min和（13.93±1.62）min,T95分别为（47.68 ±9.74） min和（43.99±10.10）min,组间比较差异均有统计学意义（P＜0.05）.T0、TOFr75、手术持续时间两组差异无统计学意义（P＞0.05）.与C组停肌松即刻的PaCO2 （38.48±2.24）mmHg相比,R组PaCO2为（52.30±5.55）mmHg;两组患者停肌松即刻pH值分别为7.39±0.02和7.29±0.04,组间比较差异均有统计学意义（P＜0.05）.两组患者在拔管后均未发生呼吸功能不全,且术后24 h也未出现呼吸系统并发症.结论 后腹腔镜手术所致的高二氧化碳血症可以延长顺式阿曲库铵的恢复时间,强化其肌松效应,导致顺式阿曲库铵的用量减少.Objective To eompare the difference of muscle relaxation between retroperitoneal laparoscopic surgery and non-laparoseopic surgery by using close-loop muscle relaxant injection system. Methods Thirty patients （ASA I -III） underwent elective surgery were selected. They were divided into two groups： the retroperitoneal laparoscopic surgery group （group R） and non-laparoseopic snrgery group （group C）. The induction was performed with fentanyl, etomidate and eisatracurium. During the maintenance of anesthesia, propofol, renfifentanil were continually infused, and cisatraeurium was given by the close-loop muscle relaxant injection system. The following parameters were recorded： the onset time （T0）, recovery index （RI）, the time from drug withdrawal to T1 recovering to 95% （T95）, the time between drug withdrawal and TOF recovering to 75% （TOFr75）, the duration of operation, and the consumption of cisatracuriun]. Arterial hlood samples were taken before the surgery and instantly after the end of cisalraeurium injeetiun fur hlood gas analysis. The number of pa- tients with residual paralysis after extubation was recorded. Patients were tbllowed up to 24 h after operations and their respiratory complications were observed. Results Compared with group C, the RI and %s were signitieantly longer [（13.93± 1.62）rain vs. （17.10±5.25）mini and [（43.99±10.10）min vs. （47.68±9.74）mini, the consumption of cisatracurium was significantly lower [（1.8±0.6）μg/（kg .rain） vs. （1.2±0,3）μg/（kg ·min）I, meanwhile, PaCO2 was significantly higher [（38.48±2.24）mmHg vs. （52,30±5.55） mmHg} and pH was significantly lower （7.39±0.02 vs. 7.29±0.04） instantly after the end of cisatraeurium injection in group R （P 〈 0.05）. No residual paralysis and respiratory eomplieations oceurred in both groups. Conclusion The high PaC02 resuhing from retroperitoneal laparoscopic surgery can strengthen the effect of cisatracurium and decrease the sum of cisatracurium consum

关 键 词：顺式阿曲库铵 闭环输注系统 后腹腔镜手术 

分 类 号：R614[医药卫生—麻醉学]