米库氯铵持续泵注用于腹腔镜胆囊切除术维持深度肌松的半数有效剂量  

Median effective dose of mivacurium continuous infusion for maintenance of deep neuromuscular block in laparoscopic cholecystectomy

作　　者：符奕青 马益梅 李于鑫 仓静 张晓光 FU Yiqing;MA Yimei;LI Yuxin;CANG Jing;ZHANG Xiaoguang(Department of Anesthesiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院麻醉科,上海市200032

出　　处：《临床麻醉学杂志》2023年第3期270-274,共5页Journal of Clinical Anesthesiology

基　　金：上海市临床重点专科建设项目(shslczdzk03603)。

摘　　要：目的研究米库氯铵持续泵注用于腹腔镜胆囊切除术中维持深度肌松的半数有效剂量(ED 50)。方法选择择期行腹腔镜胆囊切除术患者32例,男13例,女19例,年龄18~64岁,BMI 18~30 kg/m^(2),ASAⅠ或Ⅱ级。全麻诱导采用丙泊酚、米库氯铵、麻黄碱、瑞芬太尼,气管插管完成后即刻开始持续静脉泵注米库氯铵,采用肌松监测仪测定术中强直刺激后单次刺激肌颤搐计数(PTC),深度肌松判断标准为PTC≤2。采用改良Dixon上下序贯法设定泵注速度,以9.0μg·kg^(-1)·min^(-1)为起始速率,如果从建立气腹开始至胆囊切除期间能维持PTC≤2,则下一例患者输注速率降低0.5μg·kg^(-1)·min^(-1),如上述时间段内出现PTC>2,单次推注米库氯铵0.05 mg/kg补救,并改为术中间断推注米库氯铵维持肌松,下一例患者的输注速率增加0.5μg·kg^(-1)·min^(-1)。采用概率单位回归法(Probit)计算米库氯铵持续泵注维持PTC≤2时的ED_(50)、ED_(95)及其95%可信区间(CI)。记录诱导期间血管活性药物使用情况以及不良反应等。结果共纳入32例患者,17例(53%)患者可在建立气腹至胆囊切除期间维持PTC≤2。通过Probit法计算米库氯铵持续泵注用于维持深度肌松的ED_(50)为7.70μg·kg^(-1)·min^(-1)(95%CI 6.66~8.74μg·kg^(-1)·min^(-1)),ED_(95)为14.94μg·kg^(-1)·min^(-1)(95%CI 11.82~18.07μg·kg^(-1)·min^(-1))。麻醉诱导期间使用去氧肾上腺素患者1例,使用阿托品患者1例,出现胸前区及面部皮肤潮红患者7例。结论腹腔镜胆囊切除术中维持深度肌松的米库氯铵持续泵注的ED 50为7.70μg·kg^(-1)·min^(-1)。Objective To determine the median effective dose(ED 50)of mivacurium pump infusion in maintaining deep neuromuscular block during laparoscopic cholecystectomy.Methods Thirty-two patients undergoing elective laparoscopic cholecystectomy,13 males and 19 females,aged 18-64 years,BMI 18-30 kg/m^(2),ASA physical statusⅠorⅡwere selected.General anaesthesia was induced by propofol,mivacurium,ephedrine and remifentanil.Mivacurium continuous pump infusion was started immediately after tracheal intubation.The infusion rate was set by the Dixon sequential method,and the initial dose was 9.0μg·kg^(-1)·min^(-1).The criterion for deep muscle block was PTC≤2.If PTC≤2 can be achieved from the establishment of pneumoperitoneum and maintained until removal of gall bladder,the dose of the next patient will be reduced by 0.5μg·kg^(-1)·min^(-1).If PTC>2,a single injection of 0.05 mg/kg mivacurium was administered and repeated intermittently to maintain neuromuscular block,and then the rate of infusion was increased by 0.5μg·kg^(-1)·min^(-1).Probit analysis was used to calculate ED_(50),ED_(95),and 95%confidence interval(CI).Results Thirty-two patients were enrolled.Continuous infusion of mivacurium succeeded in maintain PTC≤2 in 17 patients(53%).The ED_(50)of mivacurium continuous pump infusion to maintain deep neuromuscular block for laparoscopic cholecystectomy was 7.70μg·kg^(-1)·min^(-1)(95%CI 6.66-8.74μg·kg^(-1)·min^(-1)),and ED_(95)was 14.94μg·kg^(-1)·min^(-1)(95%CI 11.82-18.07μg·kg^(-1)·min^(-1)).During anaesthesia induction,phenylephrine was used in 1 patient and atropine was used in 1 patient.Chest and facial skin flushing occurred in 7 patients.Conclusion The median effective dose of pump infusion for maintaining deep neuromuscular block during laparoscopic cholecystectomy was 7.70μg·kg^(-1)·min^(-1).

关 键 词：米库氯铵 腹腔镜胆囊切除术 深度肌松 肌松监测 静脉输注 注射泵 

分 类 号：R614[医药卫生—麻醉学]