硫酸镁对脊柱侧弯矫形手术血流动力学、维库溴铵用量和术后寒战的影响

目的评价硫酸镁对脊柱侧弯矫形手术中血流动力学、维库溴铵用量和术后寒战的影响。方法行脊柱侧弯矫形手术患者50例,年龄1025岁,ASA分级ⅠⅡ级,随机被分为2组,每组25例：R组（术中持续以0.4μg.kg-1.min-1速率输注瑞芬太尼）;M组（术中持续以0.4μg.kg-1.min-1速率输注瑞芬太尼,并在诱导前给予硫酸镁40 mg.kg-1静脉输注,继以20 mg.kg-1.h-1的速率持续输注至缝皮）。麻醉以异丙酚（80μg.kg-1.min-1）、维库溴铵和七氟醚维持。记录手术时间、患者围手术期平均动脉压（MAP）和心率（HR）、维库溴胺和七氟醚使用量以及术后寒战的病例数。结果M组围术期MAP和HR明显低于R组（P〈0.05或P〈0.01）。M组术后寒战发生率明显少于R组（P〈0.05）;R组维库溴铵用量明显高于M组（P〈0.01）。2组的麻醉总时间和每小时七氟醚用量差异无统计学意义。结论在脊柱侧弯矫形术中持续静脉输注硫酸镁可以稳定患者血流动力学,减少术中维库溴铵用量和复苏过程中寒战的发生率。

Effects of magnesium sulphate on hemodynamics and vecuronium bromide requirements in scoliosis surgery and postoperative shivering

Objective To evaluate the effects of magnesium sulphate on hemodynamics and vecuronium bromide requirements in scoliosis surgery and postoperative shivering.Methods 50 patients scheduled for posterior scoliosis correction（ASA Ⅰ-Ⅱ,aged 10-25 years） were randomly divided into 2 groups（n=25 each）： Group R（intraoperative remifentanil at 0.4 μg·kg-1·min-1）;Group M（intraoperative remifentanil at 0.4 μg·kg-1·min-1,accompanied with an induction dose of 40 mg·kg-1 magnesium sulphate,followed by an intraoperative infusion of 20 mg·kg-1·h-1 till the suturing）.Anesthesia was maintained with propofol（80 μg·kg-1·min-1）,vecuronium bromide and sevoflurane.Total dosage of vecuronium bromide and sevoflurane,surgery duration,cases of shivering,perioperative mean arterial pressure（MAP） and perioperative heart rate（HR） were recorded.Results Perioperative MAP and HR in Group M were lower than those in Group R（P〈0.05 or P〈0.01）.The incidence of shivering was lower in Group M than in Group R（P〈0.05）.Vecuronium bromide requirements in Group R were higher than those in Group M（P〈0.01）.There were no significant differences in surgery duration and sevoflurane dosage.Conclusions Sustained perioperative supplementation of magnesium sulphate in scoliosis surgery could stabilize the hemodynamics and alleviate vecuronium bromide requirements as well as the incidence of postoperative shivering during resuscitation.