三种小剂量非去极化肌松药在无痛纤维支气管镜检查中的应用及效果  

The application and effect of three kinds of non-depolarizing muscle relaxant in painless fiberoptic bronchoscopy

作　　者：段若望[1] 宋炯[1] 李玉萍[1] 

机构地区：[1]同济大学附属上海市肺科医院麻醉科,200433

出　　处：《临床麻醉学杂志》2014年第11期1069-1071,共3页Journal of Clinical Anesthesiology

摘　　要：目的探讨临床常用的三种非去极化肌松药在无痛纤维支气管镜（纤支镜）检查中的应用及效果。方法拟行无痛纤支镜检查（超声下纤支镜淋巴结活检、气管、支气管扩张与冷冻治疗）患者120例,ASAⅠ或Ⅱ级,随机均分为四组：罗库溴铵组（R组）、维库溴铵组（V组）、顺式阿曲库铵组（CIS组）及生理盐水组（N组）。患者静脉麻醉诱导意识消失后,采用TOF-Guard肌松监测仪进行肌松监测,三组肌松药组均单次5s内静脉注射1倍ED95剂量的肌松药,待T1达到最大抑制时,置入三通喉罩,丙泊酚靶控输注维持麻醉。记录三种肌松药起效时间、恢复指数、TOFR 0.9恢复时间。并记录患者麻醉前（T0）、意识消失时（T1）、喉罩置入即刻（T2）、纤支镜检查即刻（T3）、检查完毕清醒即刻（T4）的MAP、HR,喉罩置入条件分级以及纤支镜操作时间。结果与N组比较,R、V和CIS组喉罩置入条件与分级均呈现明显优势。与N组比较,T0、T1时R、V和CIS组血流动力学指标差异均无统计学意义;T2~T4时R、V和CIS组MAP明显低于,HR明显慢于N组（P〈0.05）。与CIS组比较,R组起效时间明显缩短（P〈0.05）,恢复指数明显降低（P〈0.05）。结论罗库溴铵较维库溴铵、顺式阿曲库铵更有利于短时纤支镜检查的全麻诱导与维持。Objective To evaluate the application and effect of three kinds of non-depolarizing muscle relaxant in painless fiberoptic bronchoscopy.Methods One hundred and twenty ASA Ⅰ orⅡ patients undergoing painless fiberoptic bronchoscopy were randomly divided into 4groups（n=30）：rocuronium group（group R）,vecuronium group（group V）,cisatracurium group（group CIS）and control group（group N）.After being induced by general anesthetics,neuromuscular blocking effects on the patients（groups R,V and CIS）were monitored by TOF-guard accelerogragh,after which the patients of the three groups received a single bolus of corresponding muscle relaxant（rocuronium 0.3mg/kg,vecuronium 0.05mg/kg,cisatracurium 0.05 mg/kg）in five seconds,and the group N received 5ml normal saline solution.Three-way laryngeal mask airway was inserted when the maximum depression of T1 came,and all groups were maintained with target controlled infusion of propofol.The onset time,the recovery index（time of T1 recover from 25% to 75%）and TOF ratio to 90%were recorded.MAP,HR were also noted at following time points：before anesthesia（T0）,the time of unconsciousness（T1）,the time of inserting laryngeal mask airway（T2）,when operating fiberoptic bronchoscopy（T3）and the time of waking up（T4）.fiberoptic bronchoscopy operate time and laryngeal mask airway condition classification were recorded,too.Results compared with group N,the laryngeal mask airway condition classification of the muscle relaxants had obvious advantage（P 0.05）,and at T2-T4,the MAP,HR of the groups R,V and CIS were lower than group N（P〈0.05）.The onset time and the recovery index of group R were shorter than groups V and CIS.Conclusion Rocuronium was more available in painless fiberoptic bronchoscopy.

关 键 词：非去极化肌松药 无痛纤维支气管镜 

分 类 号：R614[医药卫生—麻醉学]