体温对老年人顺式阿曲库铵与罗库溴铵恢复时相影响的比较

目的比较不同体温对老年患者术后顺式阿曲库铵和罗库溴铵肌肉松弛恢复的影响。方法择期在全身麻醉下行手术的老年患者80例,随机分为顺式阿曲库铵不保温、顺式阿曲库铵保温、罗库溴铵不保温及罗库溴铵保温组,每组20例。采用全身麻醉联合硬脊膜外腔阻滞麻醉,全身麻醉诱导气管插管时给予顺式阿曲库铵0.15mg/kg或罗库溴铵0.6mg/kg,术中肌肉松弛药经静脉输液泵输注维持,持续监测肌肉松弛和鼻咽温度,记录患者的药物累积剂量,手术时间,静脉注射肌肉松弛药到第1个肌颤搐高度(T1)最大抑制的时间(起效时间),T1从25%恢复到75%的时间(肌肉松弛恢复指数),T1恢复至25%到4个成串刺激(TOF)比值(TOFR,即TOF中第4个肌颤搐高度与T1的比值)恢复至90%的时间(完全恢复时间),以及麻醉诱导时、T1恢复至25%时、TOFR恢复至90%时的温度。结果术毕两个不保温组的体温显著低于两个保温组(P值均<0.01)。顺式阿曲库铵不保温、顺式阿曲库铵保温组的起效时间均显著长于罗库溴铵不保温、罗库溴铵保温组(P值均<0.01),肌肉松弛恢复指数则显著短于罗库溴铵不保温、罗库溴铵保温组(P值均<0.01)。顺式阿曲库铵保温组的完全恢复时间显著短于罗库溴铵保温组(P<0.01)。给予同一肌肉松弛药的两个保温组间起效时间的差异无统计学意义(P>0.05),而肌肉松弛恢复指数和完全恢复时间均显著短于两个不保温组(P值均<0.05)。结论老年患者容易发生术中低体温,保温有助于肌肉松弛的恢复,且应用于顺式阿曲库铵的效果尤佳。

Effect of body temperature on muscle relaxation recovery of cisatracurium and rocuronium in elderly patients

Objective To investigate the effect of body temperature on the postoperative relaxation recovery of cisatracurium and rocuronium in elderly patients. Methods Eighty elderly patients scheduled for elective surgery were randomly divided into the following 4 groups: non-heat preserving cisatracurium group, heat preserving cisatracurium group, non-heat preserving rocuronium group, and heat preserving rocuronium group (n=20). All patients received general anaesthesia combined with epidural anaesthesia. Intubation was conducted with cisatracurium 0.15 mg/kg or rocuronium 0.6 mg/kg according to the grouping. Muscle relaxants were infused by venous pump during operation. The temperature and muscle relaxation parameters were recorded during the whole procedure, including the onset time and accumulated dose of the relaxant; operation time, durations of T1 recovery to 25%, 50% and 75%; durations of TOFR recovery to 90%; nasopharyngeal temperatures at induction; 25%T1 recovery and 90%TOFR recovery. Results Patients in the non-heat preserving groups had a lower body temperature compared with the heat preserving groups after surgery (P<0.01). The onset time (T1 100%to 0) of cisatracurium were longer than that of rocuronium, while the recovery index (T1 25%to 75%) of cisatracurium was significantly shorter than that of rocuronium (P<0.01). In the heat preserving groups, the total recovery time (T1 25%to TOFR 90%) of cisatracurium was also significantly shorter than that of rocuronium (P<0.01). There were no significant differences with respect to the onset time of the same muscle relaxants, while the recovery index and total recovery time of heat preserving groups were significantly shorter than those of non-heat preserving groups (P<0.01). Conclusion Hypothermia often occurs in elderly patients during surgery. Heat protection is helpful to the recovery of muscle relaxation, especially when with cisatracurium.