顺势阿曲库铵在老年甲状腺手术中喉返神经监测中运用  

Application of Cis-atracurium in the Monitoring of Recurrent Laryngeal Nerve in Elderly Patients

作　　者：段红[1] 杜艺[1] 李文瑶[1] 谭晓红[1] 

机构地区：[1]四川省肿瘤医院麻醉科,四川成都610041

出　　处：《四川医学》2017年第3期280-282,共3页Sichuan Medical Journal

摘　　要：目的探索不同剂量顺式阿曲库铵配合吸入麻醉在老年甲状腺术中喉返神经监测中运用。方法选择90例甲状腺手术患者,年龄65~75岁,排除经评估插管困难者。随机分为1个ED95组(A组)、2个ED95组(B组),4个ED95组(C组),每组各30例。三组都在Narcotrend麻醉深度监测下进行麻醉。麻醉开始静脉输入咪达唑仑2mg,舒芬太尼0.5μg/kg,同时给予面罩吸入七氟醚,当麻醉深度到达D1-D2状态时,A组给予顺式阿曲库铵0.05mg/kg(1个ED95),B组给予顺式阿曲库铵0.1mg/kg(2个ED95),C组给予顺式阿曲库铵0.2mg/kg(4个ED95),面罩机控给氧至肌肉松弛进行气管插管,记录插管时间。术中使用七氟醚维持麻醉,麻醉深度维持D1-D2状态。手术暴露喉返神经,记录暴露喉返神经时间,同时进行喉返神经诱发肌电位监测,之后每5min监测一次喉返神经诱发肌电位,共监测30min。结果插管时间:A组>B组>C组,差异有统计学意义(P<0.05),喉返神经暴露时间约为手术开始后30min,各组差异无统计学意义(P>0.05)。A组共有7例患者术中出现体动反应,而B、C组无术中发生体动反应现象发生。A组术中体动反应现象明显高于B、C组,差异有统计学意义(P<0.05)。在喉返神经暴露后,A组与B组喉返神经诱发肌电位差异无统计学意义(P>0.05),而C组在各时间点诱发肌电位下降,差异有统计学意义(P<0.05)。结论 2个ED95的顺式阿曲库铵对术中喉返神经监测无影响,插管时间合适,术中无体动,是适合老年患者甲状腺术中喉返神经监测的合适肌松剂量。Objective To explore the application of different doses of cis-atracurium combined with inhalation anesthesia in the monitoring of recurrent laryngeal nerve in thyroid surgery of elderly patients. Methods 90 cases of patients to undergo thy-roid surgery,aged 65 to 75 years old and excluding those evaluated to have intubation difficulties,were randomly divided into 1 fold ED95 group（group A）,2 folds ED95 group（group B）,4 folds ED95 group（C group）,30 cases in each group. Anesthesia of the three groups were conducted under the monitoring of Narcotrend. 2mg midazolam,0. 5μg/kg sufentanil were given intravenously at the beginning of anesthesia and in the meantime,sevoflurane were given by mask inhalation. When anesthetic depth reached D1 to D2 state,group A was given cis-atracurium 0. 05mg/kg（1 fold ED95）,group B was given cis-atracurium 0. 1mg/kg（2 folds ED95） and group C was given cis-atracurium 0. 2mg/kg（4 folds ED95）. Oxygen was supplied by mask mechanical control till muscle re-laxation,endotracheal intubation was preformed then and intubation time was recorded. Anesthesia was maintained by sevoflurane during operation and anesthetic depth was maintained at D1 to D2 level. Recurrent laryngeal nerve was exposed by operation and the time point was recorded. Meanwhile,evoked potential monitoring of recurrent laryngeal nerve was conducted and after that,e-voked potential of recurrent laryngeal nerve was monitored every 5 minutes, totally 30 minutes. Results Intubation time：group A〉group B〉group C,the differences were statistically significant（P〈0. 05）. Recurrent laryngeal nerve exposure time was about 30 minutes after the beginning of operation,but there was no statistically significant difference among the three groups（P〉0. 05）. There were 7 cases occurring motor response during operation in group A,but no cases of motor response during operation in group B and C. Motor responses during operation in group A were significantly more than group B and C,the difference being sta

关 键 词：顺式阿曲库铵 老年患者 手术 喉返神经监测 

分 类 号：R614[医药卫生—麻醉学]