闭环靶控输注罗库溴铵深度肌松用于妇科腹腔镜手术的效果  

Efficacy of closed-loop target-controlled infusion of rocuronium for deep neuromuscular blockade in gynecological laparoscopic surgery

作　　者：王刚[1] 闫东来[1] 马浩南 陈旭红[3] 刘洋 于泳浩[1] Wang Gang;Yan Donglai;Ma Haonan;Chen Xuhong;Liu Yang;Yu Yonghao(Department of Anesthesiology,General Hospital of Tianjin Medical University,Tianjin 300052,China;Department of Anesthesiology,Tianjin Teda Hospital,Tianjin 300457 China;Department of Obstetrics and Gynecology,the Fifth Central Hospital of Tianjin,Tianjin 300450,China;Department of Anesthesiology,Tianjin Jizhou District People′s Hospital,Tianjin 301900,China)

机构地区：[1]天津医科大学总医院麻醉科,300052 [2]天津泰达医院麻醉科,300457 [3]天津市第五中心医院妇产科,300450 [4]天津市蓟州区人民医院麻醉科,301900

出　　处：《中华麻醉学杂志》2020年第9期1113-1116,共4页Chinese Journal of Anesthesiology

基　　金：吴阶平医学基金会临床科研专项资助基金(320.6750.18179)。

摘　　要：目的评价闭环靶控输注罗库溴铵深度肌松用于妇科腹腔镜手术的效果。方法择期妇科腹腔镜手术患者50例,年龄18~64岁,体重指数<30 kg/m2,ASA分级Ⅰ或Ⅱ级,通过计算机生成的随机数字表法分为2组(n=25):传统经验组(T组)和闭环靶控深度肌松组(CLTC组)。T组间断手动给药;CLTC组采用闭环靶控输注罗库溴铵,目标肌松程度为强直刺激后计数(PTC)计数l或2。记录术者满意度评分、平均气腹压、肌松药用量、气管拔管时间、术后氟比洛芬酯使用情况和并发症发生情况。结果与T组比较,CLTC组术者满意度评分升高,平均气腹压降低,罗库溴铵总用量及平均用量升高,气管拔管时间延长,术后氟比洛芬酯使用率、肩痛及恶心、呕吐发生率降低(P<0.05)。结论以PTC为反馈模式闭环靶控输注罗库溴铵可用于妇科腹腔镜手术深度肌松的维持,提供更加满意的手术条件,且安全性较高。Objective To evaluate the efficacy of closed-loop target-controlled infusion of rocuronium for deep neuromuscular blockade in gynecological laparoscopic surgery.Methods Fifty American Society of Anesthesiologists physical statusⅠorⅡpatients,aged 18-64 yr,with body mass index<30 kg/m2,scheduled for elective gynecological laparoscopic surgery,were allocated into 2 groups(n=25 each)using a random number table method:traditional experience group(group T)and closed-loop target-controlled infusion of rocuronium for deep neuromuscular blockade group(group CLTC).Manual administration was given intermittently in group T.In group CLTC,rocuronium bromide was given by closed-loop target-controlled infusion,and the target muscle relaxation was considered as post-titanic count(PTC)of 1 or 2.The operator′s satisfaction score,mean pneumoperitoneum pressure,consumption of muscle relaxants,extubation time,postoperative requirement for flurbiprofen,and occurrence of complications were recorded.Results Compared with group T,the operator′s satisfaction score was significantly increased,mean pneumoperitoneum pressure was decreased,and the total and average consumption of rocuronium was increased,the extubation time was prolonged,and the postoperative requirement for flurbiprofen and incidence of shoulder pain and nausea and vomiting were decreased in group CLTC(P<0.05).Conclusion The closed-loop target-controlled infusion of rocuronium in the feedback mode of PTC can be used for the maintenance of deep neuromuscular blockade in gynecological laparoscopic surgery,providing more satisfactory surgical conditions with higher safety.

关 键 词：药物释放系统 雄甾烷醇类 腹腔镜检查 

分 类 号：R614[医药卫生—麻醉学]