不同给药方式的顺式阿曲库铵深肌松应用于老年腹腔镜结直肠癌根治术患者的临床观察  

Clinical observation of different administration methods of cisatracurium deep muscle relaxant used in elderly patients with colorectal cancer undergoing laparoscopic radical resection

作　　者：郝建礼 张维清 黄泽清 HAO Jian-li;ZHANG Wei-qing;HUANG Ze-qing(Department of Anesthesiology,Cancer Hospital of China Medical University,Liaoning Cancer Hospital,Shenyang 110042,China)

机构地区：[1]中国医科大学肿瘤医院/辽宁省肿瘤医院麻醉科,辽宁沈阳110042

出　　处：《实用药物与临床》2022年第3期209-213,共5页Practical Pharmacy and Clinical Remedies

摘　　要：目的探讨不同给药方式的顺式阿曲库铵在老年腹腔镜结直肠癌患者的应用,为临床用药提供理论依据。方法选择2020年8月-2021年9月在我院行气管内全身麻醉腹腔镜辅助结直肠癌手术,预计手术时间>3 h,术中需使用非去极化肌松药的老年患者160例,随机分为间断静脉注射组(对照组)和持续泵注组(观察组),每组80例。麻醉全部采用全凭静脉麻醉,两组麻醉诱导均给予丙泊酚1.5 mg/kg,舒芬太尼0.5μg/kg,BIS<60时,给予顺式阿曲库铵0.15 mg/kg,肌松监测T_(1)消失时行气管插管,麻醉维持采用丙泊酚4 mg/(kg·h)泵注,瑞芬太尼0.2μg/(kg·min)泵注,舒芬太尼间断追加,根据肌松监测情况对照组间断追加顺式阿曲库铵0.05 mg/kg;观察组插管后给予1~3μg/(kg·min),始终保持患者处于深肌松状态,即TOF(4个成串刺激)=0和PTC(强直后刺激计数)≤2,手术结束前30 min停止肌松药。记录患者入室时、气管插管即时、手术切皮时、手术1 h、手术2 h和手术结束关腹时的平均动脉压和心率;记录手术开始时、手术1 h、手术2 h、关腹时4个时点L-SRS量表评分;记录给予肌松药诱导剂量至T_(1)消失的时长、给予肌松诱导剂量至PTC≥3的时长、停肌松药至T_(1)出现恢复时长、记录停肌松药至TOFr恢复至25%、75%和90%时长以及拔管时的TOFr,记录两组的拔管时间和肌松残余发生率。结果患者手术1 h、手术2 h和手术结束关腹时的平均动脉压和心率,观察组显著低于对照组(P<0.05);手术1 h、手术2 h和关腹时的L-SRS量表评分,观察组显著高于对照组(P<0.05);观察组的药物恢复时间即从停止肌松药到TOFr恢复到25%、75%和90%的时间均显著短于对照组(P<0.05),观察组的拔管时肌松残余率显著低于对照组(P<0.05)。结论老年腹腔镜结直肠癌根治术中麻醉采用深肌松状态能有效满足手术的要求,术中持续泵注肌松药与间断推注相比,术中血流动力学更平稳,�Objective To explore the application of cisatracurium in elderly patients with colorectal cancer undergoing laparoscopic radical resection with different administration methods,and provide a theoretical basis for clinical medication.Methods A total of 160 elderly patients with colorectal cancer undergoing laparoscopy-assisted colorectal cancer surgery under endotracheal general anesthesia from August 2020 to September 2021 in our hospital were selected.The operation time was expected to be more than 3 hours,and non-depolarizing muscle relaxants were used during the operation.They were randomly divided into intermittent intravenous injection group(control group)and continuous pump injection group(experimental group),with 80 cases in each group.All anesthesia was performed under total intravenous anesthesia.Propofol(1.5 mg/kg)and sufentanil(0.5μg/kg)were given to the two groups during anesthesia induction.When BIS was less than 60,cisatracurium(0.15 mg/kg)was given.Tracheal intubation was performed when T_(1) disappeared.Propofol 4mg/(kg·h)was pumped for anesthesia maintenance,remifentanil 0.2μg/(kg·min)was used for pump injection,and sufentanil was intermittently added.According to muscle relaxation monitoring,cisatracurium(0.05 mg/kg)was intermittently added to the control group.The experimental group was given 1-3μg/(kg·min)after intubation,and the patients were maintained in deep muscle relaxation state,namely four series stimulation(TOF=0)and post-tonic stimulation count(PTC≤2).The muscle relaxant was stopped 30 minutes before the end of the operation.Mean arterial pressure and heart rate were recorded on admission,tracheal intubation,skin incision,and at 1 hour,2 hour,3 hour and the end of surgery.The L-SRS scores were recorded at the beginning of the operation,1 hour of the operation,2 hours of the operation and closing the abdomen.Record the time from muscle relaxant induction dose to T_(1)=0,the time from muscle relaxant induction dose to PTC≥3,the time from stopping muscle relaxant to recovery o

关 键 词：顺式阿曲库铵 深肌松 老年麻醉 腹腔镜 结直肠癌根治术 

分 类 号：R614[医药卫生—麻醉学] R735.34[医药卫生—外科学]