全麻下抑制经尿道膀胱肿瘤电切术诱发闭孔神经肌肉反应的适宜肌松程度  

Optimal degree of neuromuscular blockade for inhibiting obturator nerve-muscle responses induced by transurethral resection of bladder tumor with general anesthesia

作　　者：周懿[1] 赵珍珍[1] 邓小明[1] 刘毅[1] 

机构地区：[1]第二军医大学长海医院麻醉科,上海市200433

出　　处：《中华麻醉学杂志》2016年第12期1428-1430,共3页Chinese Journal of Anesthesiology

摘　　要：目的 探讨全麻下抑制经尿道膀胱肿瘤电切术诱发闭孔神经肌肉反应的适宜肌松程度.方法 择期全麻下膀胱侧壁肿瘤电切患者90例,ASA分级Ⅰ-Ⅲ级,性别不限,年龄26～ 64岁,体重50～ 80 kg.采用随机数字表法分为3组：米库氯铵低剂量组（L组）、中剂量组（M组）和高剂量组（H组）,麻醉诱导期静脉注射米库氯铵0.15 mg/kg后,L组、M组、H组分别以0.2、0.3和0.4mg·kg-1·h-1的速率静脉输注至手术结束.术中持续监测肌松深度.当单个刺激肌肉收缩百分比（T1％）和四个成串刺激计数（TOFC）消失时,通过强直刺激后单个刺激计数（PTC）监测肌松深度.采用ROC曲线分析闭孔神经肌肉反应发生与肌松程度的关系.结果 电切肿瘤时16例患者（L组15例,M组1例）记录到T1％和TOFC,均发生闭孔神经肌肉反应;74例患者T1％和TOFC消失,肌松监测记录到PTC值分别为10.0±3.1（L组,n=15）、6.0±3.5（M组,n=29）和4.0±2.2（H组,n=30）,其中有18例（L组10例,M组8例）发生闭孔神经肌肉反应;PTC值预测闭孔神经肌肉反应发生的ROC曲线下面积0.882,最佳诊断值为9,敏感度和特异度分别为87.3％和72.2％.结论 全麻下经尿道膀胱肿瘤电切术中抑制闭孔神经肌肉反应的适宜肌松程度为PTC值≤9.Objective To evaluate the optimal degree of neuromuscular blockade for inhibiting obturator nerve-muscle responses induced by transurethral resection of bladder tumor （TURBT） with general anesthesia.Methods Ninety American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients of both sexes,aged 26-64 yr,weighing 50-80 kg,scheduled for elective TURBT for lateral bladder wall tumors with general anesthesia,were divided into 3 groups （n =30 each） using a random number table：low-dose mivacurium group （group L）,medium-dose mivacurium group （group M） and high-dose mivacurium group （group H）.After mivacurium 0.15 mg/kg was injected intravenously during anesthesia induction,mivacurium was continuously infused at a rate of 0.2,0.3 and 0.4 mg· kg-1 · h-1 in L,M and H groups,respectively,until the end of operation.Neuromuscular blockade was continuously monitored during operation.When T1% and TOF count （TOFC） disappeared,post tetanic count （PTC） was used.ROC curve was applied to analyze the relationship between the occurrence of obturator nerve-muscle responses and degree of neuromuscular blockade.Results T1% and TOFC were recorded in 16 patients （15 cases in group L,1 case in group M） during the resection of tumor,and the obturator nerve-muscle response was observed in all of these patients.In the other 74 patients,T1% and TOFC disappeared,and PTC recorded was 10.0±3.1 （group L,n=15）,6.0± 3.5 （group M,n=29） and 4.0±2.2 （group H,n=30）.Among the 74 patients,the obturator nerve-muscle response was found in 18 patients （8 cases in group L,10 cases in group M）.The area under the ROC curve of PTC value in predicting the occurrence of obturator nerve-muscle responses was 0.882 with a PTC cut-off of 9 （P〈0.05）.The sensitivity and specificity were 87.3% and 72.2%,respectively.Conclusion In order to inhibit the obturator nerve-muscle response during TURBT with general anesthesia,the optimal degree of neuromuscular blockade should be kept not more than 9 for PTC.

关 键 词：麻醉 全身 泌尿外科手术 闭孔神经 神经肌肉阻滞 

分 类 号：R614[医药卫生—麻醉学] R737.14[医药卫生—外科学]