新斯的明用于腹腔镜胃肠手术后拮抗残余肌松的临床研究  

Clinical application of neostigmine in antagonizing postoperative residual curarization after elective laparoscopic gastrointestinal surgery

作　　者：陈秋芬 闵苏[1] 余畅[1] 律峰[1] 张雨晞[1] CHEN Qiufen;MIN Su;YU Chang;LYU Feng;ZHANG Yuxi(Department of Anesthesiology,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016;Department of Anesthesiology,Liaocheng People’s Hospital,Liaocheng,Shandong Province,252000,China)

机构地区：[1]重庆医科大学附属第一医院麻醉科,重庆400016 [2]聊城市人民医院麻醉科,山东聊城252000

出　　处：《陆军军医大学学报》2023年第8期825-834,共10页Journal of Army Medical University

基　　金：重庆市卫生适宜技术推广项目(2021jstg026)。

摘　　要：目的探讨新斯的明的不同给药时机和剂量对于其拮抗腹腔镜胃肠手术患者全身麻醉恢复期内罗库溴铵残余肌松作用的效果的影响。方法本研究采用平行随机对照研究设计方案,选取2021年11月至2022年2月在重庆医科大学附属第一医院经腹腔镜下行胃肠择期手术患者220例,随机分为4组(每组55例):4个成串刺激计数(train-of-four count,TOFC)=1时,给予0.04 mg/kg新斯的明+0.02 mg/kg阿托品组(A_(1)组);TOFC=1时,给予0.06 mg/kg新斯的明+0.03 mg/kg阿托品组(A_(2)组);4个成串刺激比值(train-of-four ratio,TOFr)=0.4时,给予0.04 mg/kg新斯的明+0.02 mg/kg阿托品组(B_(1)组);TOFr=0.4时,给予0.06 mg/kg新斯的明+0.03 mg/kg阿托品组(B_(2)组)。记录并对比分析患者手术前的身体和生理特征、患者手术中的生理、用药、手术、麻醉、出血量以及苏醒和镇静等相关信息;监测并记录给予拮抗药物前后血流动力学参数值;对比分析从末次使用肌松药开始至肌松恢复到TOFC=1、TOFC=3、TOFr=0.4、TOFr=0.7及TOFr=1.0所需时间以及拔除气管导管后TOFr的变化。结果临床试验中剔除了18例患者,最终收集202例患者的数据进行统计分析。从末次应用罗库溴铵开始,A_(1)、A_(2)、B_(1)和B_(2)组肌松恢复至TOFr=1.0所需时间分别为94.53 min(95%CI:92.84~96.23)、85.88 min(95%CI:84.91~86.86)、75.08 min(95%CI:72.95~77.20)和68.30 min(95%CI:66.53~70.07),差异有统计学意义(P<0.05);拔管后除B_(2)组外,A_(1)、A_(2)、B_(1)组都有患者发生了术后肌松残余(postoperative residual curarization,PORC)。A_(1)、A_(2)、B_(1)组的PORC发生率分别是14.29%(95%CI:5.94%~27.24%)、7.84%(95%CI:2.18%~18.88%)和1.92%(95%CI:0.05%~10.26%),与B_(2)组相比,差异有统计学意义(P<0.05)。结论对于在麻醉恢复期内的腹腔镜胃肠手术患者,在肌松自主恢复到TOFr=0.4时给予0.06 mg/kg新斯的明+0.03 mg/kg阿托品可快速拮抗罗库溴铵的残余肌松作用,减少PORC的发生。ObjectiveTo investigate the clinical effects of the timing and dosage of neostigmine on its antagonistic effects on postoperative residual curarization(PORC)induced by rocuronium in patients undergoing laparoscopic gastrointestinal surgery during recovery of general anesthesia.MethodsA total 220 patients undergoing elective laparoscopic gastrointestinal surgery in the First Affiliated Hospital of Chongqing Medical University from November 2021 to February 2022 were recruited in this study.They were randomly divided into 4 groups,with 55 patients in each group.After spontaneous muscle relaxation recovery to train-of-four count(TOFC)=1,the patients in groups A_(1) and A_(2) were intravenously given 0.04 mg/kg neostigmine+0.02 mg/kg atropine and 0.06 mg/kg neostigmine combined with 0.03 mg/kg atropine,respectively.In contrast,after spontaneous muscle relaxation recovery instead to train-of-four ratio(TOFr,T4/T1)=0.4,the patients in groups B_(1) and B_(2) were intravenously given 0.04 mg/kg neostigmine+0.02 mg/kg atropine and 0.06 mg/kg neostigmine+0.03 mg/kg atropine,respectively.The physical and physiological characteristics of the patients before operation,and the physiological parameters,medication,operation,anesthesia,bleeding volume,awakening and sedation of the patients during operation were recorded and analyzed comparatively.Hemodynamic changes before and after the administration of neostigmine were monitored and recorded.The durations from the last administration of muscle relaxant to different stages of muscle relaxation recovery,defined by the values of TOFC=1,TOFC=3,TOFr=0.4,TOFr=0.7 and TOFr=1.0,were analyzed comparatively.The changes in TOFr after extubation were also analyzed comparatively.ResultsEighteen patients were excluded from the trial,and,consequently,202 patients were finally enrolled.The A_(1),A_(2),B_(1) and B_(2) groups took 94.53(95%CI:92.84~96.23),85.88(95%CI:84.91~86.86),75.08(95%CI:72.95~77.20)and 68.30 min(95%CI:66.53~70.07),respectively,to recover to TOFr=1.0 from the last administra

关 键 词：新斯的明 罗库溴铵 术后肌松残余 腹腔镜检查 

分 类 号：R619[医药卫生—外科学] R655[医药卫生—临床医学] R971.91