腹腔镜与开腹手术中单次输注罗库溴铵或顺式阿曲库铵后神经肌肉阻滞时间的比较  

Comparison of the duration of neuromuscular blockade following a single bolus dose of rocuronium or cisatracurium in laparoscopic gynaecological surgery and conventional open surgery

作　　者：王婷婷[1] 孙申[1] 王琦[1] 黄绍强[1] 

机构地区：[1]复旦大学附属妇产科医院麻醉科,上海200090

出　　处：《复旦学报（医学版）》2017年第2期150-154,174,共6页Fudan University Journal of Medical Sciences

基　　金：上海市卫计委青年局级课题(201344196)~~

摘　　要：目的比较腹腔镜与开腹手术中单次输注罗库溴铵或顺式阿曲库铵后神经肌肉阻滞时间。方法 100例全麻下行择期妇科手术的女性患者根据手术方式分为2组,各组再随机分为罗库溴铵组和顺式阿曲库铵组,共计4组,分别为罗库溴铵开腹组(OR组)、顺式阿曲库铵开腹组(OC组)、罗库溴铵腹腔镜组(LR组)和顺式阿曲库铵腹腔镜组(LC组),每组25例。每位患者均静脉推注舒芬太尼0.5μg/kg和丙泊酚2 mg/kg,待意识消失后按组别分别静脉推注罗库溴铵0.9 mg/kg或顺式阿曲库铵组0.15 mg/kg。记录罗库溴铵或顺式阿曲库铵注射后第1个成串刺激(T1)出现的时间及T1恢复到基础值的5%和25%的时间。结果 OC组和LC组相比,神经肌肉阻滞时间的差异无统计学意义。LR组与OR组相比,推注罗库溴铵后T1出现的时间、T1恢复到基础值的5%及25%的时间均显著延长(P<0.05)[(36.2±4.0)min vs.(44.8±10.7)min,(41.8±6.8)min vs.(52.8±11.2)min,(49.5±7.5)min vs.(62.6±13.5)min]。结论需警惕罗库溴铵用于腹腔镜手术时神经肌肉阻滞时间的延长,必要时进行肌松监测。Objective To compare the duration of neuromuscular blockade in laparoscopic and open surgical approaches following a single bolus dose of rocuronium or cisatracurium.Methods One hundred female patients underwent either laparoscopic or open gynaecological surgery were randomly and equally divided into OR group （rocuronium administered in open surgery）, OC group （cisatracurium administered in open surgery）, LR group （rocuronium administered in laparoscopic surgery） and LC group （cisatracurium administered in laparoscopic surgery）. Anaesthesia was induced with sufentanil of 0.5 μg/kg and propofol of 2 mg/kg, and neuromuscular blockade was induced with rocuronium of 0.9 mg/kg or cisatracurium of 0.15 mg/kg, intravenously. Then adductor pollicis train-of-four responses following ulnar nerve stimulation were monitored with mechanomyography. We recorded the duration of the first twitch （T1） occurrence after the injection of rocuronium or cisatracurium, and the duration from T1 recovered to 5% and 25% of baseline. Results The mean time from the end of injection of rocuronium until spontaneous recovery to T1, and to recovery to 5% and 25% of baseline, was significantly prolonged in LR group [（44.8±10.7） min, （52.8±11.2） min and （62.6±13.5） min] compared with OR group [（36.2±4.0） min, （41.8±6.8） min and （49.5±7.5） min]（P all〈0.05）. On the other hand, there was no significant difference on the duration of neuromuscular blockade between LC group and OC group. Conclusions Neuromuscular blockade may be prolonged following a single bolus dose of rocuronium given during laparoscopic procedures, which should be on the alert, and assess neuromuscular function to ensure safe recovery.

关 键 词：气腹 神经肌肉阻滞 腹腔镜 肌松药 

分 类 号：R614.24[医药卫生—麻醉学]