全身麻醉后复苏室患者术后肌松残余发生率的调查研究  

Incidence of Postsurgical Residual Neuromuscular Blockades among Patients Transferred to Postanesthetic Care Unit after General Anesthesia

作　　者：易声华[1,2] 蒋宗明[1,2] 陈忠华[1,2] 

机构地区：[1]浙江省绍兴市人民医院麻醉科 [2]浙江大学绍兴医院,312000

出　　处：《医学研究杂志》2014年第6期138-141,共4页Journal of Medical Research

摘　　要：目的 肌松残余（RNMB）是并发症发生的重要因素之一,确定全身麻醉后复苏室患者术后神经肌肉不完全恢复的发生率.方法 全身麻醉后转运至复苏室患者,由一位独立的麻醉医生通过肌松加速度仪测量神经肌肉传递速度,4个成串刺激比值≥0.9和＜0.9作为判定神经肌肉阻滞完全和不完全恢复的标准.记录相关患者手术信息、麻醉医生信息和药物处理等.结果 180例男性患者和240例女性患者,平均年龄54.3±15.9岁.在麻醉恢复室肌松残余发生率为31％.使用丙泊酚麻醉的患者较七氟醚RNMB发生率高分别为27.3％和15.2％.肝胆外科和胃肠外科手术发生RNMB比率较高,分别为32％和28％.RNMB主要发生在上午11点～下午2点（54％）,上午8点～上午11点和下午2点～下午5点分别为22％和24％.RNMB住院医师处理发生率较高为42％,而主治医师、副主任医师和主任医师职称间无统计学差异.结论 笔者医院麻醉恢复室不完全性神经肌肉恢复的发生率为31％,需要重视肌肉松弛剂合理应用和加强围手术期肌松监测.Objective Residual neuromuscular blockades（RNMB） plays an important role in postoperative complications. To deter mine the incidence of postsurgical residual neuromuscular blockades among patients transferred to postanestheticcare unit after generalanes thesia. Methods An independent anaesthesiologist measured neuromuscular transmission by the TOF Watch SX acceleromyography. Train of four ratios at least 0.9 and less than 0.9 were standardized as complete and incomplete neuromuscular recovery following general anaesthesia,respectively. And related informations were recorded, such as anesthetist responsible for anesthesia, surgical type, etc. Results Totally 180 men and 240 women were enrolled into the study. The incidence of residual neuromuscular blockade was 31% a mong these cases. Incomplete neuromuscular recovery was more frequent in patients given propofol than in those exposed to sevo？ urane （27.3% vs. 15.2% ）. There is incidence of RNMB among hepatobiliary（ 32% ） and gastroenterology（28% ） surgery, time interval was between 11 am and 2pm （54%） and residents were more frequent（42% ）. Conclusion The average incidence of RNMB was 31% among patients admitted to postanesthetic care unit after general anesthesia. There is urgent need to optimize neuromuscular dosage and imple ment perioperative neuromuscular monitoring.

关 键 词：肌松残余 4个成串刺激 全身麻醉 麻醉复苏室 

分 类 号：R614[医药卫生—麻醉学]