| 13例胸腺瘤合并重症肌无力手术的异丙酚—阿曲库铵麻醉 |
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| 引用本文： | 郭兵, 宋振国, 高鲁渤. 13例胸腺瘤合并重症肌无力手术的异丙酚—阿曲库铵麻醉[J]. 中国肿瘤临床, 2005, 32(7): 389-391. |
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| 作者姓名： | 郭兵 宋振国 高鲁渤 |
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| 作者单位： | 天津医科大学附属肿瘤医院麻醉科, 天津市 300060 |
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| 摘 要： | 目的: 探讨胸腺瘤合并重症肌无力的患者手术麻醉中,应用非去极化肌松剂-阿曲库铵的可行性剂量及恢复程度. 方法: 13例胸腺瘤合并明显重症肌无力患者,为实验组(Ⅰ组).术前口服抗胆碱酯酶药物及激素预处理.入手术室后在肌松监测仪监测下静注阿曲库铵0.5mg/kg,并记录4个串刺激完全消失时间,后维持追加阿曲库铵0.2mg/kg.手术结束后均用新斯的明拮抗.无合并重症肌无力的胸腺瘤患者14例为对照组(Ⅱ组). 结果: Ⅰ组患者给肌松药后起效时间为下降至20%以下为1min 50s,维持时间25～35min.Ⅱ组起效时间为2min 5s,维持时间为约20～30min.能达到肌松较完全(T1<25%)者,Ⅰ组约为96%～98%,Ⅱ组为80%～90%.手术结束后Ⅰ组用新斯的明0.05mg/kg、阿托品0.02mg/kg拮抗残余肌松作用,效果不明显者10min再追加1次.Ⅱ组用同样剂量拮抗10min内T4/T1比值达到0.75,达到拔管标准,不需再追加拮抗剂. 结论: 术前应用激素及抗胆碱酯酶药物作为预处理,对控制症状、改善全身情况、有积极作用.术前虽然使用抗胆碱酯酶物治疗,但并未明显降低阿曲库铵的敏感性.此外,手术后用新斯的明拮抗残余肌松时需仔细监测,并酌情增大拮抗药剂量才能完全恢复以保证患者安全.
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| 关 键 词： | 胸腺瘤 重症肌无力 麻醉 肌松药 拮抗剂 |
| 文章编号： | 1000-8179(2005)07-0389-03 |
| 收稿时间： | 2004-08-18 |
| 修稿时间： | 2004-10-18 |
The Study of the Anesthesia with Propofol-Atracurium in Operations on the Patients with Thymoma Combining Myasthenia Gravis |
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| Guo Bing, Song Zhenguo, Gao Lubo. The Study of the Anesthesia with Propofol-Atracurium in Operations on the Patients with Thymoma Combining Myasthenia Gravis[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2005, 32(7): 389-391. |
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| Authors: | Guo Bing Song Zhenguo Gao Lubo |
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| Affiliation: | Department of Anesthesiology, Cancer Hospital of Taanjin Medical University, Tianjin |
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| Abstract: | Objective :To investigated the feasible dose and the recovery degree of non-depolarized muscle relaxant atracurium in the patients with thymoma combining myasthenia gravis during anesthesia course. Methods :Twenty-seven patients were selected and divided into two groups at random. Group I was the trial group, in which 13 cases had obvious myasthenia gravis symptom. These pabents received ant〔cholinesterase drug orally and hormone treatment before operation. In operation room atracurium O.5mg/kg was injected in vein under the muscle relaxant monitoring and the time for the 4 trains to disappear thoroughly was recorded, 500n after atracurium 0.2mg/kg was injected in vein to maintain the muscle relaxed. Neostigmine was injected in vein to suppress the relaxed muscle after operation. Group II was the control group, in which 14 cases had no myasthenia gravis symptom. Results :In group I,the onset time was 1 min 50 s and the holding time was about 25 to 35 min, after atracurium was injected in vein. In group II,the onset time was 2 min 5 s and the holding time was 20 to 30 min. For those whose musclelax was fairly completed, the rate was 96% to 98% in group I and 80% to 90% in group II .In group I,neostigmine O.O5mg/kg and atropine 0.02mg/kg were injected in vein respectively, antagnize the remnant effect of muscle-relax after operation. If the effect was not obvious, the same dose of neostigmine and atropine were of neostigmine and atropinere used and the ratio ofgiven 10 min later. In group II, the same T4/T1 amounted to 0.75 within 10 min, dose thus meeting the requirementplication of hormone and of extubation. It is not necessary to administrate again. Conclusions :on controlling the symptom and improving the general condition of the body. Though the anticholinesterase drug therapy has been used before operation, it fails to decrease the sensibitity of atracurium obviously. In addtion, it needs careful monitoring for use of neostigmine to antagnize the muscle relax, and increase the dosage according to circumstance to achieve complete recovery of the mus- cular strength, thus ensuring the patients's safety. |
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| Keywords: | Thymoma Myasthenia gravis Anesthesia Muscle relaxant Antagonist |
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