罗库溴铵对全麻患者面罩通气时胃内进气的影响  

Effects of rocuronium on gastric insufflation related to facemask ventilation in general anaesthesia patients

作　　者：励春颖 卢波[2] 孟波[2] 范晓翔[3] 吴国荣[2] 张燕[3] 陈骏萍[2] 祝胜美[1] 

机构地区：[1]浙江大学医学院附属第一医院麻醉科,杭州310003 [2]宁波市第二医院麻醉科 [3]宁波市第二医院介入治疗科

出　　处：《中华医学杂志》2015年第32期2616-2619,共4页National Medical Journal of China

摘　　要：目的 使用超声实时监测胃窦进气情况,观察罗库溴铵对面罩通气时胃内进气的影响.方法 选取2014年6至10月宁波市第二医院接受择期喉罩全麻患者80例.年龄18～65岁,美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级,体质指数（BMI）＜ 30 kg/m^2.随机分为2组（n=40）：罗库溴铵组（R组）和无肌松对照组（C组）.患者以丙泊酚、瑞芬太尼麻醉诱导,R组予罗库溴铵,C组予等量生理盐水,随后以压力控制模式[气道压力15 cmH2O（1 cmH2O =0.098 kPa）]行面罩通气,同时超声实时观察患者胃窦部进气情况.记录通气前后胃窦面积大小和通气前后胃窦面积差值大小、胃窦有无进气、面罩通气期间各项呼吸参数.结果 与面罩通气前相比,R组和C组面罩通气后胃窦面积分别为（579.5±167.3）、（508.1±112.2）mm^2,高于通气前的（479.4±110.2）、（451.2±103.4）mm^2,差异有统计学意义（t=5.938、4.302,均P＜0.001）;根据胃内有无进气将2组患者进一步分为R＋、R-、C＋、C-4个亚组,R＋、C＋组面罩通气后胃窦面积分别为（647.7±150.6）、（546.2±121.1） mm^2,高于通气前的（501.2± 113.6）、（422.6±101.5） mm^2,差异有统计学意义（t =7.885、8.719,均P＜0.001）,R-、C-组面罩通气后胃窦面积分别为（496.0±150.9）、（489.8±105.1） mm^2,相比通气前的（452.9±102.8）、（465.0±103.3） mm^2,差异无统计学意义（t=1.793、1.663,均P＞0.05）;R＋组通气前后胃窦面积差值为（146.6±87.2） mm^2,大于R-组的（43.1±102.1）mm^2;差异有统计学意义（t =3.458,P＜0.001）,C＋组通气前后胃窦面积差值为（123.6±51.1）mm^2,大于C-组的（24.8±77.4） mm^2,差异有统计学意义（t=4.172,P＜0.001）;R＋组和C＋组相比,通气前后胃窦面积差值间的差异无统计学意义（t=0.983,P＞0.05）.R组、C组胃内进气概率分别为55％（22/18）和32.5％ （13/27）,差异有统计学意义（χ^2=4.114,P＜0.05）.2组患�Objective To explore the effect of rocuronium on gastric insufflation related to facemask ventilation in general anaesthesia patients.Methods Eighty patients from June to October 2015 undergoing elective operation under general anaesthesia at Ningbo NO.2 Hospital,ASA Ⅰ or Ⅱ grade,aged 18-65,were enrolled in this study and divided into two groups （n =40）：Group R （rocuronium） and Group C （for control）.Facemask pressure-controlled ventilation was started after general anaesthesia induced with propofol and remifentanil for a 2 min period while gastric insufflation was detected by ultrasonography of the antrum.The cross-sectional antral area（CSA） was measured using ultrasonography before and after facemask ventilation.Respiratory parameters were also recorded.Results Compared to the antral area before FMV,the CSA significantly increased in group R and C after FMV [post-FMV：（579.5 ± 167.3）,（508.1 ± 112.2）mm^2;pre-FMV（479.4 ± 110.2）,（451.2 ± 103.4） mm^2;t =5.938,4.302,P 〈0.001].All the patients were divided into four subgroups according to the gastric insufflation （R ＋,R-,C ＋,C-） and there were significant increases in the values of CSA before and after FMV in groups R ＋ and C ＋ [post-FMV （647.7 ± 150.6）,（546.2 ± 121.1） mm2;pre-FMV （501.2 ± 113.6）,（422.6 ± 101.5） mm^2;t =7.885,8.719,P 〈0.001],without any significant increase in groups R-and C-[post-FMV（496.0 ± 150.9）,（489.8 ± 105.1） mm^2;pre-FMV （452.9 ± 102.8）,（465.0 ± 103.3） mm^2;t =1.793,1.663,P 〉 0.05].Compared with the group R-,the CSA of group R ＋ significantly increased before and after FMV [group R＋（146.6±87.2） mm^2;group R-（43.1 ±102.1）mm^2;t=3.458,P〈0.001];compared with the group C-,the CSA of group C ＋ significantly increased before and after FMV [group C ＋ （123.6 ± 51.1） mm^2;group C-（24.8 ± 77.4） mm^2;t =4.172,P 〈 0.001];there was no significant difference between the difference value of CSA in groups R ＋ and C ＋ before a

关 键 词：胃窦面积 胃进气 罗库溴铵 超声检查 

分 类 号：R614[医药卫生—麻醉学]