罗库溴铵预注法在神经监测下甲状腺肿瘤全麻手术中的应用  

Application of rocuronium priming principle for general anesthesia induction on intraoperative neuromonitoring in thyroid tumor surgery

作　　者：潘伟 姚兰 张永强 冯雪辛[2] PAN Wei;YAO Lan;ZHANG Yongqiang;FENG Xuexin(Department of Anesthesiology,Peking University International Hospital,Beijing 102206,China;Department of Anesthesiology,Xuanwu Hospital Capital Medical University,Beijing 100053,China)

机构地区：[1]北京大学国际医院麻醉科,北京102206 [2]首都医科大学宣武医院麻醉科,北京100053

出　　处：《现代肿瘤医学》2023年第10期1904-1908,共5页Journal of Modern Oncology

摘　　要：目的:观察预注罗库溴铵对米库氯铵快诱导全麻气管插管条件及甲状腺肿瘤手术中神经监测(IONM)的影响。方法:回顾性分析2019年1月至2021年10月在神经监测技术下行甲状腺肿瘤手术的全麻患者90例,按照肌松剂不同的给药方式分为3组:M组(米库氯铵组)诱导期静注米库氯铵0.15 mg/kg;R组(罗库溴铵组)诱导期静注罗库溴铵0.6 mg/kg;P组(预注组)诱导期先静注罗库溴铵0.06 mg/kg, 3 min后静注米库氯铵0.15 mg/kg,每组30例。比较三组一般情况;全麻诱导肌松剂注入完毕至TOF为最小值时间(T1);肌松剂注入完毕至气管内插管成功时间(T2);气管内插管条件评分;肌松剂注入完毕至TOF恢复达75%时间(T3)和TOF恢复达90%时间(T4);术中神经监测反应情况及术后相关并发症等。结果:P组T1和T2均比M组明显缩短;P组Cooper法气管插管条件评分与R组类似,均优于M组;P组T3、T4与M组无统计学差异,均短于R组;神经监测满意率R组相对较低,与P组和M组有统计学差异。提示R组可能对甲状腺肿瘤手术中初次IONM准确性造成影响,而M组和P组均对IONM无影响。结论:全麻诱导期预注罗库溴铵可加快米库氯铵肌松作用达峰时间,快速提供较好气管内插管条件,而对甲状腺肿瘤手术IONM实施无影响。Objective:To observe the effect of priming low-dose rocuronium on conditions of tracheal intubation in rapid induced general anesthesia with mivacurium and intraoperative neuromonitoring(IONM)of thyroid tumor surgery.Methods:A total of 90 patients who had general anesthesia for thyroid tumor surgery with IONM since Jan 2019 to Oct 2021 were analyzed retrospectively.According to different ways of administration,they were divided into 3 groups:Group M(mivacurium group)received intravenous injection of 0.15 mg/kg mivacurium during induction.Group R(rocuronium group)received intravenous injection of 0.6 mg/kg rocuronium during induction.Group P(priming rocuronium group)received intravenous injection of low-dose(0.06 mg/kg)rocuronium at the beginning of induction,followed by intravenous injection of 0.15 mg/kg mivacurium about 3 minutes later,30 patients in each group.General conditions were compared.Duration from completion of muscle relaxant injection to TOF value drops to minimum(T1).Duration from completion of muscle relaxant injection to endotracheal intubation is done(T2).Endotracheal intubation condition scoring.Guration from completion of muscle relaxant injection to TOF value recovers to 75%(T3)and 90%(T4).IONM response and postoperative complications were recorded.Results:T1 and T2 of group P was significantly shorter than group M.Cooper's scoring for grading intubation result from group P was similar to group R,which was superior to score in group M.There was no statistically significant difference between group P and group M in T3 and T4,which was shorter than group R.IONM satisfaction of group R was relatively low,and had the statistical differences with group P and group M.Group R may affect the accuracy of the initial IONM in thyroid surgery,while group M and P have no effect on it.Conclusion:Priming low-dose rocuronium during induction of general anesthesia can accelerate the peak time of mivacurium,with better endotracheal intubation condition and no impact on IONM of thyroid tumor surgery.

关 键 词：预注法 罗库溴铵 米库氯铵 术中神经监测 甲状腺肿瘤手术 

分 类 号：R736.1[医药卫生—肿瘤]