舒更葡糖钠对老年肺结核患者肺叶切除术后罗库溴铵血药浓度及肌松恢复的影响  

Effect of sugammadex on plasma concentration of rocuronium and muscle relaxation recovery in elderly patients with pulmonary tuberculosis after lobectomy

作　　者：张鑫 刘涛[2] 史志国[2] 翟文廷 陈玢[2] 刘伟[2] Zhang Xin;Liu Tao;Shi Zhiguo;Zhai Wenting;Chen Bin;Liu Wei(Department of Anesthesiology,Beijing Tuberculosis and Thoracic Tumor Research Institute,Beijing 101149,China;Department of Anesthesiology,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]北京市结核病胸部肿瘤研究所麻醉科,北京101149 [2]首都医科大学附属北京胸科医院麻醉科,北京101149

出　　处：《中国防痨杂志》2023年第5期493-498,共6页Chinese Journal of Antituberculosis

基　　金：通州区高层次人才发展支持计划(YHLJ202008)。

摘　　要：目的:评价舒更葡糖钠对老年肺结核患者肺叶切除术后罗库溴铵血药浓度和肌松恢复的影响。方法:选择2021年9月20日至2022年7月5日首都医科大学附属北京胸科医院行全身麻醉下肺结核肺叶切除术的老年患者68例,采用计算机生成随机序列方法随机分为观察组与对照组,每组各34例。在排除观察组4例、对照组3例后,最终纳入观察组30例和对照组31例进行分析。使用0.6 mg/kg罗库溴铵麻醉诱导,术中用罗库溴铵维持4个成串刺激计数(train of four stimulation count,TOFC)为0。术毕当4个成串刺激计数中第2个肌颤搐(T_(2))再现时,观察组给予2 mg/kg舒更葡糖钠拮抗肌松,对照组给予0.05 mg/kg新斯的明+0.025 mg/kg阿托品拮抗肌松。使用液相色谱串联质谱法测定T_(2)、肌松拮抗后5 min和30 min时罗库溴铵的血药浓度;记录从T_(2)分别恢复到4个成串刺激比值(train of four stimulation ratio,TOFR)=0.7、0.8和0.9的时间;记录肌松拮抗前及拮抗后1、2、3、5 min的平均动脉压(MAP)和心率(HR);记录自主呼吸恢复时间、拔管时间和术后住院时间。结果:肌松拮抗后5 min和30 min,观察组罗库溴铵血药浓度分别为(82.9±13.9)μg/ml和(68.1±9.9)μg/ml,均明显高于对照组[(66.1±19.7)μg/ml和(44.0±16.0)μg/ml],差异均有统计学意义(t=3.837、7.046,P值均<0.001)。观察组TOFR恢复到0.7、0.8、0.9的时间分别为(2.0±0.9)min、(2.5±1.1)min和(3.9±2.8)min,均较对照组明显缩短[(7.3±3.6)min、(10.2±5.1)min和(15.8±7.8)min],差异均有统计学意义(t=-7.829、-8.087和-7.878,P值均<0.001)。观察组自主呼吸恢复时间、拨管时间和住院时间分别为(12.1±5.4)min、(15.5±6.6)min和(7.1±2.1)d,对照组自主呼吸恢复时间、拨管时间、住院时间分别为(17.4±7.3)min、(19.5±7.0)min和(8.6±3.4)d,两组比较差异均有统计学意义(t=-3.215、-2.295和-2.065,P=0.002、0.025和0.043)。结论:老年肺结核患者胸腔镜肺叶切除术后使Objective:To evaluate the effect of sugammadex on muscle relaxation recovery and rocuronium plasma concentration in elderly patients with pulmonary tuberculosis after lobectomy.Methods:Sixty-eight elderly patients undergoing pulmonary lobectomy for pulmonary tuberculosis under general anesthesia in Beijing Chest Hospital affiliated to Capital Medical University were selected and randomly divided into an observation group and a control group by computer-generated random sequence from September 20,2021,to July 5,2022,with 34 cases in each group.Four patients were excluded from the observation,and three from the control group.Thus 30 patients of the observation group and 31 patients of the control group were included in the analysis.Anesthesia was induced with 0.6 mg/kg rocuronium.TOFC=0 was maintained with rocuronium during surgery.When the second twitch(T_(2))reappeared at the end of the operation,the observation group was given 2 mg/kg sugammadex while the control group was given 0.05 mg/kg neostigmine and 0.025 mg/kg atropine to antagonize muscle relaxation.Liquid chromatography-tandem mass spectrometry was used to detect rocuronium plasma concentrations at T_(2) reappearance and 5 min and 30 min after muscle relaxation antagonism.The minutes to return to TOFR=0.7,0.8,and 0.9 from T_(2) were recorded.Mean arterial pressure(MAP)and heart rate(HR)were recorded before muscle relaxation antagonism and at 1,2,3,and 5 min after antagonism,together with time of spontaneous respiratory recovery,extubation,and postoperative hospital stay.Results:The plasma concentrations of rocuronium in the observation group were(82.9±13.9)μg/ml and(68.1±9.9)μg/ml at 5 min and 30 min after muscle relaxation antagonism which were significantly higher than those in the control group((66.1±19.7)μg/ml,(44.0±16.0)μg/ml),and the differences were statistically significant(t=3.837,7.046,both P<0.001).The recovery time of TOFR to 0.7,0.8,and 0.9 in the observation group were(2.0±0.9)min,(2.5±1.1)min,and(3.9±2.8)min,respectively,which

关 键 词：结核 肺 老年 肺切除术 麻醉 神经肌肉阻滞 舒更葡糖钠 罗库溴铵 

分 类 号：R521[医药卫生—内科学] R614.2[医药卫生—临床医学]