声带手术患者全麻恢复期肌松残余的临床观察  

Clinical observation of muscle relaxation in patients with vocal cord surgery during recovery period after general anesthesia

作　　者：赵萌萌 刘颖[1] 奚春花[1] 林娜[1] 王古岩 ZHAO Mengmeng;LIU Ying;XI Chunhua;LIN Na;WANG Guyan(Department of Anesthesiology,Beijing Tongren Hospital,Capital Medical University,Beijing,100730,China)

机构地区：[1]首都医科大学附属北京同仁医院麻醉科,北京100730

出　　处：《中国耳鼻咽喉头颈外科》2021年第11期712-715,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：北京市医院管理中心临床医学发展专项(ZYLX202103)。

摘　　要：目的观察全麻声带手术患者在麻醉后恢复室中肌松残余情况。方法选取2020年7月~2021年3月行声带手术的患者,运用肌松监测观察患者到达恢复室时四个成串比值(a train-of-four rate,TOFr),根据肌松残余程度分3组,Ⅰ组:TOFr<0.7(严重肌松残余),Ⅱ组:0.7≤TOFr<0.9(轻度肌松残余),Ⅲ组:TOFr≥0.9(无肌松残余),对三组患者均给予严密护理并记录,每隔5分钟循环一次,直至TOFr≥0.9,且Aldrete评分>9,达到离开恢复室标准方可送返病房。结果 258例患者中,Ⅰ组患者96例,Ⅱ组患者137例,Ⅲ组患者25例。Ⅰ组顺式阿曲库铵应用比例高于其他两组,差异有统计学意义(P<0.01),其余麻醉用药及方式差异无统计学意义。Ⅰ组患者在恢复室血氧饱和度偏低、睁眼抬头能力差、需辅助通气发生率高、恢复室停留时间长,差异均有统计学意义(P<0.01)。结论声带手术患者术后肌松残余发生率为90.3%,严重肌松残余为37.2%;在恢复室中应用肌松监测可及时发现肌松残余,对患者安全有重要作用;与米库氯铵及罗库溴铵相比,顺式阿曲库铵术后肌松残余发生率更高。OBJECTIVE To observe the incidence of postoperative residual neuromuscular block(RNMB) of patients undergoing elective support laryngoscope vocal cord surgery in the Post-Anaesthesia Care Unit(PACU).METHODS Patients who underwent elective vocal cord surgery by laryngoscope microscopy under general anesthesia from July 2020 to March 2021 were enrolled,and a Train-of-Four rate(TOFr) was used to continuously monitor the RNMB after extubation in PACU.Patients were divided into 3 groups according to the TOFr value arriving in PACU(Group I:TOFr<0.7,Group II:0.7≤TOFr<0.9,Group III:TOFr≥0.9).For all patients,TOFr was monitored every 5 minutes until TOFr was above 0.9.The vital signs,the occurrence of hypoxemia and other respiratory adverse events in the PACU were also recorded.Patients were allowed to leave PACU until TOFr≥0.9 and the Aldrete score was>9.RESULTS Among 258 patients,there were 96 patients in Group I,137 patients in Group II,and 25 patients in Group III.The application rate of cis-atracurium in Group I was higher than that of the other two groups,and the difference was statistically significant(P<0.01).There were no statistically significant differences in the anesthesia maintenance methods and other anesthetic drugs.Compared with the other two groups of patients,patients in Group I had low blood oxygen saturation(SPO;) in PACU,poorer ability to open eyes and raise heads,a higher incidence of assisted ventilation,and a longer stay in PACU and the differences were statistically significan(P<0.01).CONCLUSION The incidence of postoperative RNMB in patients undergoing vocal cord surgery is 90.3%,the incidence of severe RNMB is as high as 37.2%.The application of TOFr in the PACU can detect the RNMB in time,which plays an important role in patient safety.Compared with micuronium and rocuronium,the incidence of RNMB after cis-atracurium is higher.

关 键 词：麻醉 全身 肌松残余 麻醉术后恢复室 声带手术 

分 类 号：R614[医药卫生—麻醉学]