麻醉恢复室中术后肌松残余的临床观察  

Residual neuromuscular block:a clinical observation in the post anesthesia care unit

作　　者：王佳艳[1] 孙学丽[1] 张晓娇[1] 刘明明[1] 黄秋瑞 徐娜[1] 王天龙[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》2015年第8期746-748,共3页Beijing Medical Journal

摘　　要：目的观察全麻患者回到麻醉恢复室(PACU)的肌松残余情况。方法选择接受全身麻醉非心脏手术、术后转入PACU的患者151例。麻醉诱导给予芬太尼和丙泊酚后,采用TOF-Watch&#174;SX加速度肌松监测仪进行肌松监测定标,记录四个成串刺激(TOF)比值基础值。然后单次给予中效非去极化肌松药罗库溴铵或顺苯磺酸阿曲库铵,进行气管插管或放置喉罩。麻醉维持采用丙泊酚、瑞芬太尼静脉输注。术毕由麻醉医生根据临床指征拔管。记录患者从拔管到入PACU的时间。回到PACU即刻开始监测TOF值,每5 min一次,共监测30 min或直到TOF比值恢复至0.9以上。结果 145例患者完成观察。回到PACU后测量的TOF比值除以定标后的TOF基础值,为修正过的TOF比值(TOFr)。TOFr<0.9者(肌松残余组)61例(42.1%),在PACU中TOFr恢复到0.9以上所需时间为(12.3±8.5)min。肌松残余组中有36例进行了肌松拮抗,而非肌松残余组(TOFr≥0.9)有49例进行拮抗,差异无统计学意义(P=0.536)。肌松残余组与非肌松残余组从拔管到PACU的时间差异有统计学意义[(13.4±6.5)min vs.(16.1±5.0)min,P=0.033],带管时间差异有统计学意义[(61.0±22.6)min vs.(97.1±52.9)min,P=0.002]。肌松残余组和非肌松残余组使用罗库溴铵者分别为13例和28例,使用顺苯磺酸阿曲库铵者分别为48例和56例,使用不同肌松药患者间肌松残余发生情况的差异无统计学意义(χ2=2.518,P=0.136)。结论肌松残余是PACU中常见的并发症。采用肌松监测仪可以有效评估患者肌松残余情况。拔管后1 h内是肌松恢复的关键时期。Objective To determine the incidence of residual neuromuscular block（RNB） in the post anesthesia care unit（PACU）.Methods One hundred and fifty-one patients who underwent non-cardiac surgery and received general anesthesia were enrolled.After the induction of etomidate and fentanyl,AMG monitoring was calibrated and continuously measured TOF for 5 min to obtain TOF baseline ratio.Then a single dose of non-depolarizing muscular blocker（NDMB）was given to the patient followed by endotracheal intubation or LMA.All patients were transported to the PACU after extubation.TOF ratio at the time of their arrivals at PACU was recorded.Results One hundred and forty-five patients completed the study.TOFr was the result of actual TOF ratio measured in PACU corrected by TOF baseline ratio.Sixty-one patients showed TOFr0.9,the incidence of residual neuromuscular block was 42.1%.Among the patients with RNB,the average time that TOFr recovering to above 0.9 was（12.3±8.5）min.Anticholinesterases were administrated in 36 patients in the RNB group,while the number was 49 in the adequate recovery group,there was no significant difference（P =0.536）.The average time from extubation to arrival at PACU was significantly different between RNB group and adequate recovery group[（13.4±6.5）min vs.（ 16.1±5.0） min,P = 0.033].Conclusion RNB is a common complication in PACU.In stead of clinical tests,neuromuscular monitoring is accurate to assess RNB.One hour after extubation is critical for RNB recovery.

关 键 词：神经肌肉阻滞剂 肌松残余 四个成串刺激 肌松拮抗药 

分 类 号：R614[医药卫生—麻醉学]