不同剂量米库氯铵在眼底日间手术中的应用  

Application of different dose of mivacurium in retinal day-case surgery

作　　者：岳建英[1] 张伊 奚春花[1] YUE Jianying;ZHANG Yi;XI Chunhua(Department of Anesthesiology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院麻醉科,100730

出　　处：《临床麻醉学杂志》2023年第6期614-617,共4页Journal of Clinical Anesthesiology

摘　　要：目的比较不同剂量米库氯铵持续输注用于喉罩全麻眼底日间手术中的安全性和对术后残余肌松的影响。方法选择择期行喉罩下全麻眼底日间手术患者60例,男35例,女25例,年龄18~65岁,BMI<30 kg/m^(2),ASAⅠ—Ⅲ级。采用随机数字表法将患者分为两组:A组和B组,每组30例。A组喉罩置入后持续输注米库氯铵0.20 mg·kg^(-1)·h^(-1)、B组喉罩置入后持续输注米库氯铵0.25 mg·kg^(-1)·h^(-1),维持术中肌松缝结膜时停止输注。记录手术时间、停止输注米库氯铵至拔除喉罩时间。记录入PACU即刻、入PACU后5、10 min的TOFr。记录皮肤潮红、呼吸系统过敏反应、体动、喉罩移位等不良事件的发生情况。结果与入PACU即刻比较,入PACU后5、10 min B组TOFr明显升高(P<0.05)。与B组比较,A组停止输注米库氯铵至拔除喉罩的时间明显缩短(P<0.05),入PACU即刻A组TOFr明显升高(P<0.05)。两组均未出现皮肤潮红、呼吸系统过敏反应、体动和喉罩移位等不良事件。结论与米库氯铵0.25 mg·kg^(-1)·h^(-1)比较,采用米库氯铵0.20 mg·kg^(-1)·h^(-1)持续输注用于喉罩全麻眼底日间手术,患者停药至拔除喉罩时间明显缩短、术后残余肌松恢复更快。Objective To investigate the safety and postoperative residual curarization(PORC)of different doses mivacurium by intravenous continuous infusion in retinal day-case surgery under general anesthesia with flexible laryngeal mask airway(LMA).Methods From June of 2021 to March of 2022,sixty patients scheduled to undergo retinal day-case surgery under general anesthesia with LMA,35 males and 25 females,aged 18-65 years,BMI<30 kg/m^(2),ASA physical statusⅠ-Ⅲ,were randomly divided into two groups:group A and group B,30 patients in each group.Group A received continuous infusion of micuronium 0.20 mg·kg^(-1)·h^(-1)after laryngeal mask placement,group B received continuous infusion of micuronium 0.25 mg·kg^(-1)·h^(-1)after laryngeal mask placement to maintain intraoperation muscle relaxation and stop infusion during conjunctiva suture.The time from stopping the infusion of micuronium chloride to removing the laryngeal mask was recorded.The TOFr at immediately after entering PACU,5 and 10 minutes after entering PACU were recorded.The symptoms of anaphylaxis in skin,respiratory circulatory allergic recation,unpredicted body movement and dislocation of LMA were recorded.Results In group B,the TOFr at 5,10 minutes after entering PACU was higher than that at immediately after entering PACU(P<0.05).Compared with group B,the timespan from discontinuing mivacurium to extubation LMA shortened significantly in group A(P<0.05),and the TOFr at immediately after entering PACU was significantly higher in group A(P<0.05).No adverse events such as skin flushing,respiratory and circulatory allergic reaction,accidental body movement and laryngeal mask displacement were found in the two groups.Conclusion Compared with 0.25 mg·kg^(-1)·h^(-1)continuous infusion of micuronium,0.20 mg·kg^(-1)·h^(-1)continuous infusion of micuronium significantly shortened the time from drug withdrawal to laryngeal mask removal,and recovery time from residual muscle relaxation after retinal day-cose surgery.

关 键 词：米库氯铵 日间手术 眼底手术 术后残余肌松 

分 类 号：R614.2[医药卫生—麻醉学]