琥珀酰胆碱与罗库溴铵用于麻醉诱导对甲状腺手术患者术中喉返神经监测的影响  

Study on the application of succinylcholine and rocuronium in the monitoring of recurrent thyroid laryngeal nerve

作　　者：徐义全 青晓艳[2] 王怀明 王朝集 陈一丁 张可贤 张宏伟 舒进军 李超 Xu Yiquan;Qing Xiaoyan;Wang Huaiming;Wang Chaoji;Chen Yiding;Zhang Kexian;Zhang Hongwei;Shu Jinjun;Li Chao(Department of Anesthesiology Medical Center,Sichuan Cancer Hospital&Institute,the Affiliated Cancer Hospital School of Medicine,University of Electronic Science and Technology,Chengdu 610041,China;Department of Oncology,Chengdu Seventh People's Hospital,Chengdu Tumor Hospital,Chengdu 610000,China;Department of Head and Neck Surgery,Sichuan Cancer Hospital&Institute,the Affiliated Cancer Hospital School of Medicine,University of Electronic Science and Technology,Chengdu 610041,China)

机构地区：[1]四川省肿瘤医院·研究所,四川省癌症防治中心,电子科技大学医学院附属肿瘤医院麻醉医学中心,成都610041 [2]成都市第七人民医院,成都市肿瘤医院肿瘤科,610000 [3]四川省肿瘤医院·研究所,四川省癌症防治中心,电子科技大学医学院附属肿瘤医院头颈外科中心,成都610041

出　　处：《国际耳鼻咽喉头颈外科杂志》2020年第1期11-15,共5页International Journal of Otolaryngology-Head and Neck Surgery

基　　金：四川省卫生和计划生育委员会课题(150238);四川省卫生计生委适宜技术推广项目(18SYJS07)。

摘　　要：目的 比较常规剂量琥珀酰胆碱与小剂量罗库溴铵用于麻醉诱导对甲状腺手术患者术中喉返神经监测的影响.方法 选取2019年4月至2019年7月本院120例同一外科医师团队甲状腺手术喉返神经监测患者,随机分为A组:麻醉诱导肌松药物为琥珀胆碱1.5 mg/kg;B组:麻醉诱导肌松药物为罗库溴铵0.3 mg/kg.麻醉医师待肌松监测显示到最大抑制后,通过气管插管条件评分评估两组患者气管插管条件.记录各组插管时间、等待时间;迷走神经和喉返神经电信号基础值;以及术中血压波动、术后咽痛、声音嘶哑、低氧血症、苏醒延迟等并发症.外科医师通过神经肌电监测仪进行喉返神经刺激评估两组患者喉返神经监测情况.结果 A组患者气管插管条件优于B组,A组插管时间、肌松监测时间小于B组,两组手术监测时间差异无统计学意义.A组首次神经监测信号值大于B组,A组首次监测例数多于B组,两组患者术中无体动,血压下降差异无统计学意义.麻醉术后并发症,A组咽痛少于B组,A组有少量患者发生肌痛,差异无统计学意义.结论 1.5 mg/kg琥珀酰胆碱用于甲状腺手术患者的麻醉诱导,可以提供较好的插管条件,不影响外科医师术中行喉返神经监测,同时减少患者术后咽痛的发生.Objective To compare the effect of conventional dose of succinylcholine and low dose of rocuronium on intraoperative monitoring of recurrent laryngeal nerve in patients undergoing thyroid surgery.Methods From April 2019 to July 2019,120 patients with thyroid recurrent laryngeal nerve monitoring by the same team of surgeons in our hospital were randomly divided into group A:the anesthesia-induced muscle relaxant was 1.5 mg/kg succinylcholine.Group B:the anesthesia-induced muscle relaxant was 0.3 mg/kg rocuronium.The anesthesiologist evaluated the conditions of endotracheal intubation in the two groups after muscle relaxant monitoring showed maximum inhibition.The intubation time and waiting time of each group were recorded.Basic values of electrical signals of vagus nerve and recurrent laryngeal nerve,and intraoperative blood pressure fluctuation,postoperative pharyngeal pain,hoarseness,hypoxemia,delayed awakening and other complications.The surgeon evaluated the recurrent laryngeal nerve monitoring in both groups by nerve EMG monitor for recurrent laryngeal nerve stimulation.Results The condition of endotracheal intubation in group A was better than that in group B,the intubation time and muscle relaxant monitoring time in group A were less than that in group B,and there was no statistically significant difference in surgical monitoring time between the two groups.The first nerve monitoring signal value in group A was higher than that in group B,and the number of first monitoring cases in group A was higher than that in group B.There was no body movement in the two groups,and there was no statistically significant difference in blood pressure decline.Complications after anesthesia were less in group A than in group B,and A small number of patients in group A had myalgia,with no statistically significant difference.Conclusion 1.5 mg/kg succinylcholine can provide better intubation conditions for anesthesia induction in patients undergoing thyroid surgery,without affecting the surgeon's intraoperative monitoring of

关 键 词：甲状腺肿瘤 喉返神经 琥珀酰胆碱 罗库溴铵 术中神经监测 

分 类 号：R614[医药卫生—麻醉学]