舒更葡糖钠使甲状腺癌根治术中喉返神经监测信号快速恢复的半数有效剂量  

ED50 of sugammadex for rapid recovery of signal of intraoperative neuromonitoring of recurrent laryngeal nerve in radical thyroidectomy

作　　者：何志斌[1] 王强 张明珠 郑晖[1] He Zhibin;Wang Qiang;Zhang Mingzhu;Zheng Hui(Department of Anesthesiology,Cancer Hospital Chinese Academy of Medical Science,Beijing 100021,China)

机构地区：[1]中国医学科学院肿瘤医院麻醉科,北京100021

出　　处：《中华麻醉学杂志》2020年第1期71-73,共3页Chinese Journal of Anesthesiology

摘　　要：目的确定舒更葡糖钠使甲状腺癌根治术中喉返神经监测信号快速恢复的半数有效剂量(ED50)。方法选择择期在喉返神经监测下行甲状腺癌根治术的患者,年龄18~64岁,性别不限,体重40~90 kg,ASA分级Ⅰ或Ⅱ级。静脉注射舒芬太尼和丙泊酚,待患者意识消失后行肌松监测;静脉注射罗库溴铵0.6 mg/kg,当肌颤搐比值为0时行气管插管术。术中通过调节罗库溴铵输注速率维持肌颤搐比值0~10%。监测喉返神经信号时,停止输注罗库溴铵,采用序贯法静脉注射舒更葡糖钠,初始剂量为2 mg/kg,若3 min内能监测到稳定的喉返神经信号视为有效,下一例患者按0.2 mg/kg的梯度递减给药;若3 min内测不出稳定的喉返神经信号则为无效,下一例患者按0.2 mg/kg的梯度递增给药。计算舒更葡糖钠的ED50及其95%可信区间。结果舒更葡糖钠使甲状腺癌根治术中喉返神经检测信号快速恢复的ED50为0.98 mg/kg,95%可信区间为0.94~1.02 mg/kg。结论舒更葡糖钠使甲状腺癌根治术中喉返神经监测信号快速恢复的ED50为0.98 mg/kg。Objective To determine the 50%effective dose(ED50)of sugammadex for rapid recovery of the signal of intraoperative neuromonitoring of recurrent laryngeal nerve in radical thyroidectomy.Methods American Society of Anesthesiologists physical statusⅠorⅡpatients of either sex,aged 18-64 yr,weighing 40-90 kg,scheduled for elective radical thyroidectomy under intraoperative neuromonitoring of recurrent laryngeal nerve,were enrolled in this study.Sufentanil and propofol were intravenously injected,and muscle relaxation monitoring was performed after the patients lost consciousness.Rocuronium 0.6 mg/kg was intravenously injected,and tracheal intubation was performed when the twitch ratio was 0.The infusion rate of rocuronium was adjusted to maintain twitch ratio 0-10%.When the signal needed to be detected,rocuronium infusion was stopped,sugammadex was injected intravenously using up-and-down sequential method,with the initial dose of 2 mg/kg.If a stable signal was detected within 3 min,the concentration decreased by 0.2 mg in the next patient,otherwise the concentration increased by 0.2 mg in the next patient.The Dixon and Massey formula was used to calculate the ED50 and 95%confidence interval of sugammadex.Results The ED50 of sugammadex for the rapid recovery of the signal of intraoperative neuromonitoring of recurrent laryngeal nerve was 0.98 mg/kg,and the 95%confidence interval was 0.94-1.02 mg/kg during radical thyroidectomy.Conclusion The ED50 of sugammadex for rapid recovery of the signal of intraoperative neuromonitoring of recurrent laryngeal nerve is 0.98 mg/kg in radical thyroidectomy.

关 键 词：喉返神经 监测 手术中 剂量效应关系 药物 舒更葡糖钠 

分 类 号：R614[医药卫生—麻醉学] R73[医药卫生—外科学]