全麻术后新斯的明拮抗时机对肌松残余作用的影响——一项随机、双盲、平行对照研究  

Effect of neostigmine antagonistic timing on residual neuromuscular blockade after general anesthesia:a randomized,double-blind and parallel controlled trial

作　　者：姚明 石慧 焦博 鲁佩 谭茜 徐卉 YAO Ming;SHI Hui;JIAO Bo;LU Pei;TAN Xi;XU Hui(Department of Critical Care Medicine,Wuhan Puren Hospital,Hubei Wuhan 430081,China;Department of Anesthesiology,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Hubei Wuhan 430030,China)

机构地区：[1]武汉市普仁医院重症医学科,湖北武汉430081 [2]华中科技大学同济医学院附属同济医院麻醉科,湖北武汉430030

出　　处：《中国医院药学杂志》2021年第2期191-194,共4页Chinese Journal of Hospital Pharmacy

摘　　要：目的:观察新斯的明拮抗时机对全麻患者术后肌松残余作用的影响。方法:随机选择90例ASA分级Ⅰ~Ⅱ级,年龄≥18岁拟进行4 h内的开腹或腹腔镜择期手术患者,采取双盲试验设计方案。根据临床指征确定新斯的明拮抗时机及拔管时间,采用TOF-WATCH SX Monitor观察肌松恢复程度。根据给予新斯的明时的TOF值分为N组(未给予新斯的明)、Ⅰ组(TOF值≤0.1)、Ⅱ组(0.10.8)。记录新斯的明拮抗时、拔管时、进入PACU时的患者TOF值;观察拔管前即刻和进入PACU时肌松残余作用的发生率,记录术后是否发生呼吸相关并发症。结果:患者在拔管前即刻以及进入PACU时均存在神经肌肉阻滞残余作用。未使用新斯的明患者的肌松恢复时间显著长于使用了新斯的明拮抗的患者(P<0.05)。当TOF比值恢复至0.1,T1约为20%~30%,给予新斯的明拮抗后肌松恢复时间最快(8.1±0.8)min(P<0.01),但TOF比值在拔管即刻(0.28±0.31)以及进入PACU时(0.72±0.16)显著低于其他TOF值范围内给予新斯的明拮抗者(P<0.05)。结论:术毕当TOF比值低于0.5时给予新斯的明拮抗,可显著缩短肌松恢复时间,使临床拔管指征提前出现,但TOF比值并未恢复至0.9,仍有可能发生肌松残余并发症。建议常规使用肌松监测,并在合适时机给予新斯的明以加快肌松恢复,减少肌松残余效应。OBJECTIVE To explore the effect of neostigmine antagonistic timing on the residual neuromuscular blockade after general anesthesia.METHODS A total of 90 patients aged ≥18 years with ASA grade I-II and scheduled for laparotomy or elective laparoscopy within 4 h were randomly selected for this double-blind trial.The timing of neostigmine antagonism and extubation were determined by the recovery degree of residual neuromuscular blockade according to clinical indications.The degrees of neuromuscular blockade and muscle relaxation recovery were observed by TOF-WATCH SX Monitor.They were divided into group N(no neostigmine),group I(TOF ratio≤0.1),group Ⅱ(0.10.8)according to the TOF value during the dosing of neostigmine.TOF values at the timepoints of neostigmine antagonism,extubation and upon entry into PACU were recorded.The incidence of immediate residual muscle relaxation before extubation and upon entry into PACU were observed.And the relationship between the effects of neostigmine at different timepoints and muscle relaxation recovery was evaluated and whether respiratory-related postoperative complications occurring was recorded.RESULTS They exhibited residual effects of neuromuscular block immediately before extubation and upon entry into PACU.The recovery time of muscle relaxation in patients without neostigmine was significantly longer than that of those with neostigmine(P<0.05).When TOF ratio recovered to around 0.1 and T1 was 20% to 30%,muscle relaxation recovery time was the fastest at(8.1±0.8)min after neostigmine antagonism(P<0.01).However,TOF ratio immediately after extubation(0.28±0.31)and upon entry into PACU(0.72±0.16)were significantly lower than those receiving neostigmine antagonists within the range of other TOF values(P<0.05).CONCLUSION After operation,when TOF ratio is<0.5,neostigmine antagonism can significantly shorten the recovery time of muscle relaxation,leading to early clinical signs of extubation.However,if TOF ratio fails to recover to 0.9,complications of residual neuromuscul

关 键 词：新斯的明 拮抗时机 TOF比值 肌松残余 

分 类 号：R969[医药卫生—药理学]