腹腔镜手术中持续输注与间断静注顺式阿曲库铵维持深度肌松的药效学比较

目的探讨持续输注顺式阿曲库铵维持深度肌松在腹腔镜手术中的有效性和安全性。方法择期行腹腔镜辅助胃肠道肿瘤根治术患者60例,年龄18~65岁,随机分为A、B两组,每组30例。A组使用顺式阿曲库铵0.15 mg/kg诱导插管,并在强直刺激后计数(post tetanic count,PTC)恢复至≥3时以初始速率0.2mg·kg-1·h-1开始泵注,术中维持肌松深度在PTC≤2。B组使用顺式阿曲库铵0.15mg/kg诱导插管,并在每次PTC恢复至≥3时间断追加0.05mg/kg,术中维持肌松深度在PTC≤2。记录肌松药使用总量,肌松药使用时间(A组:诱导至泵注结束时间;B组:诱导到最后一次加药时间),手术时间,手术开始0、1、2h及关腹时肌松满意度(0~10分),恢复指数(T1从25%恢复至75%的时间),TOFr比值恢复至0.7、0.9的时间,以及压舌板试验完成情况,低氧血症、肺不张、肺炎等情况。结果与B组比较,A组平均肌松药使用量明显增加(P0.05);在手术开始0、1、2h时手术医师对肌松满意度A组明显高于B组(P0.05);恢复指数、TOFr比值恢复至0.7的时间和TOFr比值恢复至0.9的时间两组差异无统计学意义。拔管后A组出现低氧血症2例(7.1%),B组出现低氧血症1例(4.2%);不能完成压舌板试验A组3例(10.7%),B组4例(16.7%),两组差异均无统计学意义。术后均未出现肺不张、肺炎。结论持续输注顺式阿曲库铵用于腹腔镜手术维持深度肌松安全有效。相较于间断静注给药,持续输注肌松药使用量较大,肌松满意度高,虽然停药后恢复时间稍长,但对术后肌松残余无明显影响。

Comparison pharmacodynamics of continuous or intermittent cisatracurium infusion during laparoscopy for deep neuromuscular blockade

Objective To investigate continuous infusion and inermittent injection of cisatra-curium for deep neuromuscular blockade during laparoscopic surgery and to compare the effectiveness and safety.Methods Sixty ASA Ⅰ or Ⅱ patients,aged from 18 to 65,undergoing selective laparo-scopic gastrointestinal surgery with general anesthesia were randomly divided into 2 groups:group A (n =30)received cisatracurium 0.1 5 mg/kg for intubation,and then continuous infusion of cisatra-curium with micropump at an original rate of 0.2 mg·kg-1 ·h-1 when post tetanic count (PTC)≥3;group B(n =30)was given cisatracurium 0.1 5 mg/kg for intubation,and then intermittent infusion of cisatracurium of 0.05 mg/kg when PTC≥ 3.The cisatracurium consumption,duration of neuro-muscular blocking agent used in group A from induction to the end of infusion and in group B from in-duction to the last infusion,satisfaction of neuromuscular blockade (grade 0-10)of the surgeons,the time of T1 recovered to 25%,75%,TOFr recovered to 0.7,0.9,fulfillment of tongue depressor test,the incidence of hyoxemia after extubation,pneumonia,atelectasis were recorded.Results In comparison with group B,the cisatracurium consumption in group A was significantly more (P <0.05),and the satisfaction of the surgeons was significantly higher at the beginning,1 h,2 h of the operation (P <0.05).The satisfaction of the surgeons respectively showing no significant differences between the two groups at the end of the operation.Recovery index (T1 from 25% to 75%),time of TOFr recovery to 0.7,0.9 in group A was increased,but not statistically.Two patients (7.1%)in group A had hyoxemia after extubation while 1 (4.2%)in group B,the incidence rate was not signifi-cant;3 patients (10.7%)in group A was unable to perform sustained tongue depressor test while 4 (1 6.7%)in group B,the incidence was not significant;all of the patients did not suffer pneumonia and atelectasis.Conclusion Continuous infusion cisatracurium during laparoscopic procedures for deep neuromuscular blockade is effective and safe.The dose of cisatracurium is bigger,and muscular relax-ation would be deeper compared to intermittent infusion.Continuous infusion may prolong the working time of muscle relaxant,but have on influence on the residual effect of muscle relaxant.