不同剂量葡萄糖酸钙联合新斯的明对老年患者肌松恢复的影响  

Effects of different doses of calcium gluconate combined with neostigmine on the recovery of neuromuscular blockade in elderly patients

作　　者：蒿梦潇 邢瑞 茆烨 颜明 HAO Mengxiao;XING Rui;MAO Ye;YAN Ming(Department of Anesthesiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu,China)

机构地区：[1]徐州医科大学附属医院麻醉科,江苏徐州221000

出　　处：《西部医学》2024年第11期1631-1636,1642,共7页Medical Journal of West China

摘　　要：目的探讨不同剂量葡萄糖酸钙注射液联合新斯的明在老年患者腹腔镜术后肌松恢复过程中产生的效应。方法选取2022年4月—8月于徐州医科大学附属医院行择期腹腔镜手术的老年患者180例,随机分为4组,即5、10、20 mg/kg葡萄糖酸钙注射液联合新斯的明组(C_(5)组、C_(10)组、C_(20)组)与新斯的明联合阿托品组(N组),每组40例(因20例被剔除)。术中使用四个成串刺激(TOF)模式监测肌松。术毕,待TOF计数(TOFc)≥3,静脉推注新斯的明40μg/kg配伍阿托品20μg/kg,同时C_(5)组、C_(10)组、C_(20)组分别予以葡萄糖酸钙注射液5、10、20 mg/kg静脉泵注;N组则予以等容积生理盐水。观察4组患者TOFr(T4/T1)≥0.90的时间及5、10、15、20 min的TOFr及术后肌松残余(PORC)发生情况;评估拔管时的镇静躁动(SAS)评分,麻醉后恢复室(PACU)内低氧血症、躁动、恶心呕吐、发音障碍发生情况及停留时间,同时记录心率(HR)、平均动脉压(MAP)、血钙浓度的变化。结果N组TOFr≥0.90的时间为13.00(10.25,15.00)min,C_(5)组10.50(9.00,12.00)min,C_(10)组9.50(7.00,12.00)min,C_(20)组7.50(6.00,9.00)min,差异有统计学意义(P<0.05)。C_(20)组患者拔管时的SAS评分优于N组(P<0.05)。与N组相比,钙剂组PORC发生率、低氧血症及PACU停留时间减少(P<0.05)。4组患者术后躁动、恶心呕吐、发音障碍无明显统计学差异(P>0.05)。结论葡萄糖酸钙联合新斯的明可安全用于老年患者,有效促进肌松恢复,降低术后肌松残余发生率,且C_(20)组的恢复过程更加稳定。Objective To explore the effects of different doses of calcium gluconate injection combined with neostigmine on the recovery of neuromuscular blockade(NMB)in elderly patients after laparoscopic surgery.Methods 180 elderly patients who underwent elective laparoscopic surgery at the Affiliated Hospital of Xuzhou Medical University from April 2022 to August 2022 were selected and divided into four groups randomly.Intraoperatively,the degree of NMB was monitored by four train-of-four stimulation(TOF)patterns.At the end of the operation,when the TOF count(TOFc)≥3,40μg/kg neostigmine combined with 20μg/kg atropine was injected intravenously.Meanwhile,the group C_(5)、C_(10)、C_(20) were given calcium gluconate injection 5、10、20 mg/kg combined with both neostigmine 40μg/kg and atropine 20μg/kg to antagonize NMB respectively,the group N was given equal volume of saline.The time to TOFr(T4/T1)≥0.90 and the TOFr were assessed at 5,10,15 and 20 min,and the incidence of PORC.The Ricker Sedation Agitation Scale(SAS)score at the time of extubation,hypoxemia、agitation、nausea and vomiting、dysphonia,the duration of stay in the post-anesthesia care unit(PACU)were evaluated.Changes in heart rate(HR),mean arterial pressure(MAP)and blood calcium concentration were also recorded.Results The time of TOFr≥0.90 was13.00(10.25,15.00)min in group N,10.50(9.00,12.00)min in group C_(5),9.50(7.00,12.00)min in group C_(10) and 7.50(6.00,9.00)min in group C_(20),the difference was statistically significant(P<0.05).The SAS score of group C_(20) was better than that of group N(P<0.05).Compared with group N,the incidence of PORC,hypoxemia and the duration of stay in PACU in calcium gluconate group were reduced(P<0.05).Postoperative agitation,nausea and vomiting,and dysphonia were not significantly different among the four groups(P>0.05).Conclusion Calcium gluconate can be safely used for elderly patients,promote the recovery of neuromuscular effectively,reduce the incidence of PORC,moreover,the recovery process was more stabl

关 键 词：葡萄糖酸钙 老年 术后肌松残余 苯磺顺阿曲库铵 腹腔镜手术 

分 类 号：R614.2[医药卫生—麻醉学]