肌松拮抗用于短时腹腔镜手术的临床观察

目的:观察不同剂量新斯的明肌松拮抗用于短时腹腔镜手术的疗效与副作用。方法:选择60例择期行腹腔镜卵巢囊肿剥除术的患者,采用单次插管剂量罗库溴铵全身麻醉,手术结束时随机分为3组(n=20),N0组静脉注射生理盐水5 ml,N1组静脉注射新斯的明20μg/kg、阿托品10μg/kg,N2组静脉注射新斯的明40μg/kg、阿托品20μg/kg,根据临床征象判断拔除喉罩。检测手术结束时、拔除喉罩时及10 min后四联串刺激比率(train-of-four ratio,TOFR),记录麻醉时间(麻醉诱导至手术结束)、手术时间、拔除喉罩时间(手术结束至拔除喉罩),观察肌松拮抗用药10 min内心动过速、心动过缓及拔除喉罩10 min内低氧血症(吸入空气状态脉搏血氧饱和度<93%)发生情况。随访早期(0~6 h)及延迟(7~24 h)术后恶心呕吐(postoperative nausea and vomiting,PONV)发生情况。结果:3组患者年龄、体重、麻醉时间、手术时间、拔除喉罩时间、手术结束时TOFR及拔除喉罩后10 min内低氧血症发生率差异无统计学意义(P>0.05);拔除喉罩时TOFR N1组(0.87±0.10)、N2组(0.85±0.12)高于N0组(0.55±0.15,P<0.05);拔除喉罩10 min后TOFR N1组(0.88±0.08)、N2组(0.86±0.09)高于N0组(0.62±0.16,P<0.05);肌松拮抗用药10 min内心动过速及心动过缓发生率,N2组高于N0组、N1组(P<0.05);早期PONV发生率,N2组高于N0组(P<0.05);延迟PONV发生率,3组相比差异无统计学意义(P>0.05)。结论:对于短时腹腔镜手术,采用单次插管剂量罗库溴铵全麻后,推荐采用小剂量(20μg/kg)新斯的明进行肌松拮抗。

Clinical observation on reversal of neuromuscular blockade for short-term laparoscopic operation

Objective ：To observe the therapeutic effect and side effect of different dose of neostigmine to reverse neuromuscular blockade for short-term laparoscopic operation. Methods：Sixty patients, scheduled for laparoscopic oophorocystectomy under general anesthesia with single intubation dose of rocuronium, were equally randomized into three groups （ n = 20） ： NO group received normal saline 5 ml intravenously, N1 group received neostigmine 20 μg/kg and atropine 10 μg/kg intravenously, N2 group received neostigmine 40μ~g/kg and atropine 20 μg/kg intravenously, at the end of surgery. Laryngeal mask airway （LMA） was removed based on clinical judgement such as 5-second head lift test. Train-of-four ratio （TOFR） was tested at the end of surgery, the time LMA was removed and 10 min later. Time of anesthesia （from the induction of anesthesia to the end of surgery）, time of surgery, time of LMA removal （ from the end of surgery to the time LMA was removed） were recorded. The incidence of bradycardia and taehycardia, during the following 10 min after administration of reversal agents,was recorded. The incidence of hypoxemia （defined as pulse oxygen saturation 〈93% in room air） ,during the following 10 min after LMA was removed,was also recorded. The incidence of early （0-6 h） and delayed （7- 24 h） post operative nausea and vomiting （PONV） was followed up. Results：There were no statistical differences in age, body weight, time of anesthesia, time of surgery, time of LMA removal, TOFR at the end of surgery, and the incidence of hypoxemia within 10 min after LMA was removed （P 〉0.05） ,of the three groups. N1 group （0.87 ±0. 10） and N2 group （0.85 ±0. 12） was higher in TOFR at the time LMA was removed （ P 〈 0.05 ）, versus N0 group （0.55 ±0. 15 ）. N1 group （0.88 ±0. 08 ） and N2 group （0.86±0. 09 ） was higher in TOFR 10 min after LMA was removed （P 〈0.05） ,versus NO group （0.62 ±0.16）. N2 group was higher in the incidence of bradycardi