胸科手术患者顺阿曲库铵术后残余肌松的危险因素  

Risk factors for postoperative residual neuromuscular blockade in patients surgery

作　　者：李德媛[1] 张晓峰[1] 吴镜湘[1] 邱郁薇[1] 徐美英[1] 

机构地区：[1]上海交通大学附属胸科医院麻醉科,200030

出　　处：《中华麻醉学杂志》2016年第5期563-566,共4页Chinese Journal of Anesthesiology

基　　金：上海市市级医院适宜技术课题（SHDC12014241）

摘　　要：目的筛选胸科手术患者顺阿曲库铵术后残余肌松的危险因素。方法全麻胸科手术患者733例，神经肌肉功能未见异常，皮肤温度≥32℃，术毕送人PACU行同步间歇指令通气。于入PACU即刻行肌松监测，气管拔管时TOF比值〈90％为发生术后残余肌松。根据术后是否发生残余肌松分为残余肌松组和非残余肌松组。记录患者一般资料各指标、合并疾病、手术部位和方式、麻醉时间、术中肌松药使用情况、人PACU即刻TOF比值、PACU中肌松拮抗剂使用情况和气管拔管时间。将组间差异有统计学意义的因素进行多因素logistic回归分析，筛选胸科手术患者术后残余肌松的危险因素。结果有385例患者发生术后残余肌松，发生率为52．5％。logistic回归分析的结果显示：合并糖尿病、术中使用两种肌松药、术中顺阿曲库铵平均用量≥0．14mg·kg-1·h-1、人PACU即刻TOF比值≤0．5、气管拔管时间≤30rain是胸科手术患者顺阿曲库铵术后残余肌松的独立危险因素（P〈0．05）。结论合并糖尿病、术中使用两种肌松药、术中顺阿曲库铵平均用量≥0．14mg·kg-1·h-1、入PACU即刻TOF比值≤0．5、气管拔管时间≤30min是胸科手术患者顺阿曲库铵术后残余肌松的独立危险因素。Objective To screen the risk factors for postoperative residual neuromuscular blockade （RNMB） in the patients undergoing thoracic surgery. Methods A total of 733 patients undergoing elective thoracic surgery with general anesthesia, without neuromuscular disease, skin temperature ≥ 32 ℃ , were transferred to the postanesthesia care unit （PACU） after surgery and given synchronized intermittent mandatory ventilation. Neuromuscular blockade was monitored immediately after admission to the PACU, and the occurrence of postoperative RNMB was defined as a train of four （TOF） ratio 〈90% at the time of extubation. The patients were divided into RNMB group and nonRNMB group according to whether or not postoperative RNMB occurred. Each parameter of baseline patient characteristics, complications, sites and methods of surgery, anesthesia time, requirement for muscle relaxants during surgery, TOF ratio on arrival to the PACU, requirement for muscle relaxant antagonists in the PACU, and extubation time were recorded. The risk factors of which P values were less than 0.05 would enter the multivariable logistic regression analysis to stratify the risk factors for postoperative RNMB. Results A total of 385 patients developed postoperative RNMB, and the incidence was 52.5%. The resuhs of multivariate logistic regression analysis showed that complications such as diabetes, intraoperative application of two kinds of muscle relaxants, average intraoperative consumption of cisatracurium≥0. 14 mg · kg-1· h-1, TOF ratio on arrival to the PACU ≤ 0.5, and extubation time ≤ 30 min were independent risk factors for postoperative RNMB （P〈0.05）. Conclusion Complications such as diabetes, intraoperative application of two kinds of muscle relaxants, average intraoperative consumption of cisatracurium≥0.14 mg· kg-1·h-1 , TOF ratio on arrival to the PACU ≤ 0.5, and extubation time ≤30 min are independent risk factors for postoperative RNMB in the patients undergoing thoracic surgery.

关 键 词：雄甾烷醇类 神经肌肉阻滞 手术后并发症 危险因素 胸外科手术 

分 类 号：R614.2[医药卫生—麻醉学]