米库氯铵与顺苯磺酸阿曲库铵在腹腔镜手术围拔管期的临床观察

目的探讨持续输注米库氯铵较顺苯磺酸阿曲库铵在妇科腹腔镜手术中的应用是否具有优越性。方法选择拟行择期妇科腹腔镜手术的女性患者60例,ASAⅠ-Ⅱ级,随机分成持续输注顺苯磺酸阿曲库铵组（C组）和持续输注米库氯铵组（M组）,每组30例。经闭环肌松注射系统给予肌松药,采用4个成串刺激尺神经,通过拇内收肌的收缩反应以监测TOFr值（T4/T1）。记录两组患者围拔管期血流动力学变化、脑电双频指数（BIS）、神经肌肉功能的恢复及术后不良反应等。结果 C组与M组围拔管期血流动力学指标的变化无显著性差异（P〉0.05）;在手术结束即刻（T1）及拔管即刻（T2）两个时间点M组的BIS值高于C组且PETCO2值明显低于C组,差异有统计学意义（P〈0.05）;M组的TOFr恢复至25%、恢复指数时间、TOFr恢复至90%、术毕至拔除气管导管时间,苏醒室停留时间均明显小于C组（P〈0.05）;且M组肌松起效时间明显快于C组,增药次数及单位时间内用药量明显多于C组,差异有统计学意义（P〈0.05）;M组发生术后肌松残余者较C组少。结论经闭环肌松注射系统输注米库氯铵在围拔管期神经肌肉功能恢复快,术后肌松残余者少且不良反应轻微,较顺苯磺酸阿曲库铵更适合应用于腹腔镜手术。

Clinical observation of Mivacurium and Cisatracurium Besilate on the application of periextubation period in patients un- dergoing laparoscopic surgery

Objective To investigate the advantage of Mivacurium and Cisatracurium Besilate continuous venous in- fusion on the application of periextubation period in female patients undergoing Gynecology lap~aroscopic surgery. Meth- ods Sixty female patients scheduled for Gynecology laparoscopic surgery were randomized into two groups （n ~ 30 each） ,such as Cisatracurium Besilate continuous infusion（group C） and Mivacurium continuous infusion（ group M） . Inject muscle relaxants by Close-loop muscle relaxant injection system （CLMRIS）, monitored the contract reaction of adductor pollicis through train--of-four ratio （TOFr） by stimulating ulnar nerve. Record MAP, HR, BlS,condition of re- covery from neuromuscular blockad, untoward effect after operation, et al. Results The hemodynamics index has no difference in periextubation period（P~〉 0.05） ;BIS in group M is higher than group C at Tl and T2 ,PETCO2 in group M is lower than group C obviously at T1 and T2 （P~0.05）;the recovery of TOFr to 25~,to 90~,recovery index time, finish operation to extubation time and duration of PACU in group M all are shorter than group C;onset time of group M is faster;number of patients in group M appear muscle loose residual effect is less than group C but the dosage is more（P~0.05）. Conclusion The recovery from neuromuscular blockad in periextubation period by continuous infu- sing Mivacurium is fast , rarely appear muscle residual effect and untoward effect after operation . The application of Mivacurium is better than Cisatracurium Besilate in laparoscopic surgery.