无肌松药全身麻醉下进行骨科手术的临床对照试验

目的 比较使用和不使用神经肌肉阻滞药全身麻醉下进行部分骨科手术的优缺点.方法 76例ASAⅠ或Ⅱ级骨科手术患者,随机分为试验组（T组）、对照组（C组）各38例.使用琥珀酰胆碱诱导后,T组只用丙泊酚、瑞芬太尼维持麻醉,C组按常规使用阿曲库铵.术中维持脑电双频指数（BIS值）在30～60之间,记录两组患者麻醉前,诱导后,切皮时,术后30、60 min和拔管后的BIS值和四个成串刺激比（T4/T1,TOFr）,比较两组丙泊酚和瑞芬太尼用量、睁眼时间、拔管时间、术后20 min警觉与镇静评分（OAA/S）及不良反应,术后请外科医师评价肌松效果.结果 两组患者瑞芬太尼用量、外科肌松评价、术中体动次数、血管活性药使用次数无显著差异;T组插管后各时点TOFr均显著高于C组（P ＜ 0.01）,丙泊酚用量多于C组（P ＜ 0.05）,睁眼时间、拔管时间明显短于C组（P ＜ 0.05）,拔管后BIS值显著高于C组（P ＜ 0.05）,术后20 min OAA/S评分明显低于C 组（P ＜ 0.05）.结论 无肌松药全身麻醉下进行骨科手术比使用者呼吸恢复早,拔管快,清醒程度好,具有显著优势.

Controlled clinical trials of orthopedic surgery under general anesthesia without muscle relaxants

Objective To compare the efficacy of general anesthesia with and without muscle relaxant on orthopedic surgery.Methods 76 ASA Ⅰ or Ⅱ adults underwent elective orthopedic surgery were randomly divided into 2 groups: trial group(group T) and control group(group C),with 38 cases in each group.General anesthesia was induced with Midazolam,Fentanyl,Propofol and Succinylcholine,and maintained with Propofol and Remifentanil at BIS level 30 to 60.After induction,Atracurium was used in group C but not in group T.BIS and TOFr at baseline,after induction,at skin incision,30 min and 60 min after skin incision and at extubation were recorded.The dosage of Propofol and Remifentanil,eye-opening time,extubation time and OAA/S scale 20 min after extubation and possible adverse reaction were compared.The muscle relaxation of each patient was scaled by surgeons at the end of surgery.Results The dosage of Remifentanil,muscle relaxation scale,body movements or frequencies of vasoactive medicine usage had no significant difference between the two groups.The TOFr in group T were significantly higher than group C at every time point after intubation(P < 0.01),and the dosage of Propofol in group T was higher than group C(P < 0.05).The eye opening-time,extubation time was shorter(P < 0.05) and the BIS was lower at extubation in group T as compared with group C(P < 0.05),and OAA/S scale 20 min after extubation were significantly lower in group T than in group C(P < 0.05).Conclusion General anesthesia without muscle relaxant has obvious advantages of earlier breath recovery,earlier extubation and higher level of consciousness,it can provide satisfactory operating conditions on orthopedic surgery.