比较不同剂量罗库溴铵用于关腹的临床疗效
Comparison of Different Dosages of Rocuronium on Abdominal Wound Closure
-
摘要: 目的 评价全麻下行腹部手术关腹时追加不同剂量罗库溴铵对手术肌松的影响.方法 择期全凭静脉麻醉下行开腹手术患者90例, ASA分级ⅠⅡ级, 随机分为A、B、C 3组, 分别于关腹时追加1ED95 (0.3mg/kg) 、0.5ED95 (0.15 mg/kg) 、0.2 ED95 (0.06 mg/kg) 的罗库溴铵量, 记录给药后TOF值恢复至25%、75%、90%时间、患者睁眼的时间、抬头>5 s的时间、拔出气管导管的时间、拔管后上呼吸道梗阻及手术医生对关腹时肌松满意度评分等指标.结果 3组患者关腹前的TOF值比较差异无统计学意义 (P>0.05) , 与A、B组比较, C组给药后TOF值明显延长 (P<0.05) , 给药后TOF恢复25%、75%、90%的时间点, C组比A、B组明显缩短 (P<0.01) ;与A、B组比较, C组给药后至患者睁眼的时间、抬头>5 s的时间、气管拔管的时间差异有统计学意义 (P<0.05) ;拔管后A、B、C 3组分别有8、4、0例患者在2 h内发生上呼吸道梗阻, 差异有统计学意义 (P<0.05) ;肌松满意评分3组差异无统计学意义 (P>0.05) .结论 关腹时给予0.2倍的ED95罗库溴铵可以产生有效的临床肌松作用, 无明显不良反应.Abstract: Objective To evaluate the effects of different dosages of rocuronium on abdominal wound closure under general anesthesia.Me thods Ninety ASA class I or II patients scheduled for elective abdominal surgery under general anesthesia were randomized into three groups with 30 cases each.Each group received rocuronium 1 time of ED95 (0.3 mg/kg) , 0.5 time of ED95 (0.15 mg/kg) , 0.2 time of ED95 (0.06 mg/kg) respectively when closing the abdominal wall.TOF recovered to 25%, 75%, 90%, time of eye-opening on command, time of head-lift for more than 5 seconds, extubation time, the rate of upper airways obstruction after extubation and the satisfaction score for the muscle relaxation to general surgeons were recorded.Re s ults TOF values had no significantly different among the three groups before abdominal wound closure (P>0.05) .Compared with group A and group B, time of TOF in group C was significangtly increased after administration of rocuronium (P<0.05) .Time of TOF recovery to 25%, 75%, 90% in group C were significangtly decreased (P<0.01) .Compared with group A and group B, time of eye-opening on command, head-lift for more than 5 seconds and extubation time were significantly shorter in group C.There were 8, 4, 0 patients undwent upper airways obstruction among each group respectively after extubation (P<0.05) .The satisfaction score for muscle relaxation among three groups had no significant difference.Conclus ion An additional administration of 0.2 time of ED95 (0.06 mg/kg) rocuronium before abdominal wound closure in abdominal surgery can achieve satisfactory muscle relaxation for surgeons.
-
Key words:
- Rocuronium /
- Abdominal wound closure /
- Train-of-four stimulation /
- Residual paralysis
-
[1]王祥, 杨以均, 陈为国.阿曲库铵恢复期应用琥珀胆碱的肌松效应观察[J].基层医学论坛, 2006, 10 (2) :132-133. [2] [2]ALVARELLOS M L, MCDONAGH E M, PATEL S, et al.Pharm GKB summary:succinylcholine pathway, pharmacokinetics/pharmacodynamics[J].Pharmacogenet Genomics, 2015, 25 (12) :622-630. [3]周银辉, 程丹, 张卫.罗库溴铵用于小儿唇腭裂修复术的量效关系及肌松残余的观察[J].实用口腔医学杂志, 2016, 32 (5) :708-711. [4]王佳艳, 孙学丽, 张晓娇, 等.麻醉恢复室中术后肌松残余的临床观察[J].北京医学, 2015, 37 (8) :746-748. [5] [5]MURPHY G S, SZOKOL J W, AVRAM M J, et al.Residual Neuromuscular Block in the Elderly:Incidence and Clinical Implications[J].Anesthesiology, 2015, 123 (6) :1322-1336. [6]陈帆, 朱宏亮, 钱洪军, 等.暂时性腹腔关闭与常规关腹技术治疗严重腹腔感染的临床对比[J].中国微创外科杂志, 2015, 15 (7) :628-631. [7]陈志聪, 史嘉华, 鲍亚楠, 等.新斯的明拮抗老年患者术后肌松药残留阻滞作用的量效研究[J].中国医药导报, 2014, 11 (24) :87-91. [8] [8]FORTIER L P, MCKEEN D, TURNER K, et al.The RECITE study:A canadian prospective, multicenter study of the incidence and severity of residual neuromuscular blockade[J].Anesth Analg, 2015, 121 (2) :366-372. [9] [9]LIU J, CHENG Z.Comparison of neostigmine induced reversal of rocuronium in different age children[J].Zhonghua Yi Xue Za Zhi, 2016, 96 (10) :807-811. [10]段凤梅, 孙旭颖, 李玲.两种肌松药不同给药方案对老年肥胖患者的影响[J].河北医学, 2016, 22 (7) :1106-1109. [11]邓城旗, 李萌萌, 郝建华.罗库溴铵和顺式阿曲库铵用于肝部分切除术肌松效应的比较[J].临床麻醉学杂志, 2014, 30 (5) :430-433. [12] [12]BOOIJ LHDJ, CRUL J F.A comparision vecuronium with the hypothetic ideal neuromuscular blocking drug[J].Excerpta Medica Amesterdam, 1983, 3 (2) :105-108. [13]刘龙娟, 梁良.罗库溴铵与顺式阿曲库铵用于气管插管中肌肉松弛恢复情况对比[J].中国药业, 2014, 23 (15) :89-90. [14] [14]IGARASHI A, AMAGASA S, HORIKAWA H, et al.Vecuronium directly inhibits hypoxic neurotransmission of the rat carotid body[J].Anesth Analg, 2002, 94 (1) :117-122. [15]马荣华, 杨拔贤.肌松药残余作用的评估与拮抗[J].中国医药, 2010, 5 (3) :284-286. [16] [16]VEGA E A, IBACACHE M E, ANDERSON B J, et al.Rocuronium pharmacokinetics and pharmacodynamics in the adductor pollicis and masseter muscles[J].Acta Anaesthesiol Scand, 2016, 60 (6) :734-746. [17]高佳栋, 陈海, 肖海峰, 等.新斯的明拮抗老年患者米库氯铵肌松残余的临床效果[J].临床麻醉学杂志, 2017, 33 (3) :252-256. [18] [18]PLUMMER-ROBERTS A L, TROST C, COLLINS S, et al.Residual Neuromuscular Blockade[J].AANA J, 2016, 84 (1) :57-65. [19] [19]BRULL S J.Indicators of recovery of neuromuscular function:time for change[J].Anesthesiology, 1997, 86 (7) :755-757. [20]欧阳葆怡.神经肌肉功能监测//闻大翔, 欧阳葆怡, 余卫锋.肌肉松弛药[M].上海:世界图书出版公司, 2015:102-125. -
点击查看大图
计量
- 文章访问数: 1472
- HTML全文浏览量: 552
- PDF下载量: 64
- 被引次数: 0
下载:
