葡萄糖酸钙联合新斯的明对肥胖患者胃减容术后肌松恢复的影响  

Effect of calcium gluconate combined with neostigmine on postoperative recovery from muscular relaxation after gastric reduction in obese patients

作　　者：张滢 王超昌 蒿梦潇 邢瑞 茆烨 颜明 Zhang Ying;Wang Chaochang;Hao Mengxiao;Xing Rui;Mao Ye;Yan Ming(Department of Anesthesiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China)

机构地区：[1]徐州医科大学附属医院麻醉科,江苏徐州221002

出　　处：《实用药物与临床》2022年第10期870-874,共5页Practical Pharmacy and Clinical Remedies

基　　金：江苏省教育厅高校省级重点实验室开放基金资助项目(KJS08004)。

摘　　要：目的 探究葡萄糖酸钙联合新斯的明对肥胖患者胃减容术后肌松恢复的安全性及有效性。方法 选取2020年11月至2021年10月于徐州医科大学附属医院行择期胃减容手术的肥胖患者80例,随机分为对照组和试验组,每组40例。术中采用4个成串刺激(Train-of-four stimulation,TOF)模式监测肌松程度。术毕,当TOF计数≥3时,试验组给予葡萄糖酸钙注射液20 mg/kg(去脂体重)联合新斯的明40μg/kg(去脂体重)拮抗肌肉松弛剂;对照组给予等容积生理盐水联合新斯的明40μg/kg(去脂体重)拮抗肌肉松弛剂。观察两组患者给予肌松拮抗剂后TOFr(T_(4)/T_(1))≥0.9的时间以及给予肌松拮抗剂后5 min、10 min、20 min的肌松残余发生率。同时记录给予肌松拮抗剂前后心率、血压、血钙浓度变化以及不良反应(全身发热、寒战、胸闷、头晕、注射部位疼痛、心律失常等)发生率。记录患者拔管时的镇静-躁动评分(SAS),记录术后躁动、低氧血症、恶心呕吐、术后肺部并发症发生率,记录患者恢复室(Post-anesthesia care unit,PACU)停留时间、首次下床活动时间、术后住院时间。结果 试验组肌松恢复时间明显短于对照组(P<0.05)。试验组给予拮抗药后20 min的肌松残余发生率明显低于对照组(P<0.05)。试验组患者拔管时的SAS评分比对照组有所改善(P<0.05)。试验组患者PACU停留时间比对照组降低(P<0.05)。两组患者给予拮抗剂后5 min、10 min的肌松残余发生率、术后躁动、低氧血症、恶心呕吐、肺部并发症发生率、术后首次下床时间、住院时间差异无统计学意义(P>0.05)。结论 葡萄糖酸钙联合新斯的明可安全用于肥胖患者胃减容术后肌松拮抗,能够更快地逆转罗库溴铵的肌松作用,缩短患者肌松恢复时间,降低肌松残余发生率,改善患者拔管时的SAS评分、缩短PACU停留时间,促进患者术后早期恢复。Objective To investigate the effect of calcium gluconate combined with neostigmine on postoperative recovery from muscular relaxation after gastric reduction in obese patients.Methods Eighty obese patients who underwent elective gastric reduction surgery at the Affiliated Hospital of Xuzhou Medical University from November 2020 to October 2021 were selected and divided into a control group and a test group randomly,with 40 cases in each group.Intraoperatively,the degree of muscle relaxation was monitored by four train-of-four stimulation(TOF) patterns.At the end of the operation,when the TOF count≥3,the test group was given calcium gluconate injection 20 mg/kg(lean body weight) combined with neostigmine 40 μg/kg(lean body weight) to antagonize muscle relaxation;the control group was given an equal volume of normal saline combined with neostigmine 40 μg/kg(lean body weight) to antagonize muscle relaxation.The time after the administration of muscle relaxant antagonists when TOFr(T_(4)/T_(1))≥0.9 was observed in both groups,and the incidence of residual muscle relaxation at 5 min,10 min and 20 min after the administration of muscle relaxant antagonists was recorded.Changes in heart rate,blood pressure,blood calcium concentration and the incidence of adverse effects(generalized fever,chills,chest tightness,dizziness,injection site pain,arrhythmias,etc.) were also recorded before and after the administration of the inotropic antagonist.The patient′s agitation and sedation SAS score at the time of extubation,the incidence of post-operative agitation,hypoxemia,nausea,vomiting and pulmonary complications were recorded,as well as the duration of stay in the post-anesthesia care unit(PACU),the time of first out-of-bed activity and the duration of post-operative hospital stay.Results The recovery time from muscle relaxation was significantly shorter in the test group than in the control group(P0.05).Conclusion Calcium gluconate combined with neostigmine can be safely used for postoperative myorelaxation antagonism

关 键 词：葡萄糖酸钙 肥胖 肌松残余 胃减容手术 

分 类 号：R614[医药卫生—麻醉学]