小剂量新斯的明拮抗老年患者术后肌松药轻度残留阻滞作用研究  

The Research of Small-dose Neostigmine Antagonizing Low Level Residual Paralysis in Elderly Patients after Surgery

作　　者：陈志聪[1] 彭俊[2] 鲍亚楠[1] 史嘉华[1] 黄绍农[1] 刘志恒[1] 

机构地区：[1]深圳市第二人民医院麻醉科,518035 [2]中山大学孙逸仙纪念医院麻醉科

出　　处：《岭南急诊医学杂志》2015年第3期211-213,共3页Lingnan Journal of Emergency Medicine

摘　　要：目的:探讨全麻术后苏醒期使用新斯的明拮抗老年患者顺式阿曲库铵轻度残留阻滞作用的量效关系。方法:将全麻苏醒期老年患者80例随机分为4组,每组20例,当四个成串刺激比值(TOFR)恢复至0.7时,分别单次静脉注射生理盐水3 ml(S0组),新斯的明5μg/kg(S5组)、10μg/kg(S10组)和20μg/kg(S20),均用生理盐水稀释至3 ml。记录给药后TOFR恢复到1.0的时间、10 min内TOFR恢复到1.0的比率、给药前、给药后第3、5、10 min心率(HR)、血压值以及术后6 h内恶心呕吐的发生率。结果:与S0组比较,S10组及S20组TOFR恢复到1.0所需时间均明显缩短(5.0 min vs 13.0 min和2.5 min vs 13.0 min,P<0.01);S10组及S20组10 min内TOFR恢复到1.0的比率升高(P<0.05)。与给药前比较,第3、5、10 min的HR在S20组明显降低(P<0.05),而在S10组无显著改变。各组术后恶心呕吐的发生率差异无统计学意义。结论 :老年患者全麻苏醒期,当肌松恢复至TOFR 0.7时,使用10μg/kg新斯的明可在10 min内有效地拮抗肌松残留阻滞作用,而对心率无明显影响,且不增加术后恶心呕吐的发生率。Objective ：To explore the effect relationship of small-dose neostigmine antagonizing low level residual paralysis（TOFR =0.7） induced by cisatracurium in elderly patients after surgery. Methods ： 80 elderly patients scheduled for elective surgery were enrolled and randomly assigned into 4 groups,each group was 20 cases. When the Train-of-Four Ratio（TOFR） returned to 0.7 after surgery, 5 μg / kg, 10 μg / kg and 20 μg / kg neostigmine dissolved in 0.9% normal saline 3ml and 0.9% normal saline 3 ml were administered intravenously in group S5,group S10,group S20 and group S0, respectively. Then,time needed for TOFR to 1.0 was recorded,the success rate of full reversal within 10 minutes was calculated,heart rate（HR） and blood pressure（BP） were recorded just before administration and 3 min, 5 min and 10 min after administration. Postoperative nausea and vomiting within 6 h in each group were compared. Results ：Time needed for TOFR to 1.0 in group S10 and group S20 were significantly less than that in group S0（5.0 min vs 13.0 min and 2.5 min vs 13.0 min respectively,P〈0.01）. The success rates of full reversal in group S10 and group S20 were significantly increased（P〈0.05） when compared to group S0. HR in group S20 was significantly lower at 3 min,5 min and 10 min after administration when compared to the value recorded just before drug administration（P〈0.05）. There were no statistical differences in PONV among all the groups within 6 h（P〈0.05）. Conclusion ： When given at TOFR 0.7 in elderly patients after surgery, 10μg / kg neostigmine was needed for successful reversal the residual paralysis of cisatracurium within 10 min, with no influences on the heart rate and incidence of PONV.

关 键 词：老年人 肌松残留 拮抗 新斯的明 顺阿曲库铵 

分 类 号：R614[医药卫生—麻醉学]