单次插管剂量罗库溴铵残余肌松作用对妇科腹腔镜术后早期肺功能的影响

Effects of Residual Paralysis after a Single Intubating Dose of Rocuronium on Postoperative Pulmonary Function of Patients Undergoing Laparoscopic Gynecological Surgeries

目的探讨单次插管剂量罗库溴铵术后残余肌松作用及其对妇科腔镜术后早期肺功能的影响。方法将60例行妇科腹腔镜手术患者随机分为罗库溴铵组(R组)和罗库溴铵+新斯的明组(R+N组)两组,每组30例。所有患者均以0.02 mg/kg咪唑安定、1.0μg/kg芬太尼、1.5～2.0 mg/kg异丙酚和0.6 mg/kg罗库溴铵麻醉诱导后行气管内插管,以异氟烷和N_2O/氧气(N_2O∶O_2=1∶1)维持麻醉,术毕R组患者不进行肌松拮抗,R+N组患者以0.04 mg/kg新斯的明和0.02μg/kg阿托品进行肌松拮抗。术毕测定拔管后即刻和到达麻醉监护室(PACU)即刻拇内收肌的4个成串刺激(TOF)比值,并分别在术前、咪唑安定和芬太尼镇静后、拔管后即刻、到达PACU即刻和TOF比值恢复到1.0等5个时间点测定用力肺活量(FVC)、1秒钟用力呼气量(FEV_1)和呼气峰流速(PEFR),比较两组患者残余肌松和肺功能情况。结果拔管后即刻和到达PACU即刻,R组平均TOF比值显著低于R+N组(P<0.05);R组TOF比值恢复到0.9和1.0的时间较R+N组显著延长(P<0.05)。R组在拔管后即刻和到达PACU即刻的FVC、FEV_1和PEFR显著低于R+N组(P<0.05)。所有患者在咪唑安定和芬太尼镇静后,TOF比值恢复至1.0后的FVC、FEV_1和PEFR明显低于术前对照值(P<0.01)。结论大部分单次应用插管剂量罗库溴铵的妇科腹腔镜手术患者术后存在不同程度残余肌松作用。妇科腹腔镜手术患者即使在TOF值达1.0后肺功能仍明显减低。

Objective To evaluate the residual paralysis after a single intubating dose of rocuronium and its effect of residual paralysis after a single dose of rocuronium on the postoperative pulmonary function of patients undergoing laparoscopic gynecological surgeries.Methods Sixty American Society of Anesthesiologists (ASA)Ⅰ-Ⅱpatients undergoing laparoscopic gynecological surgeries were randomly divided into rocuronium (R) group(n=30) and rocuronium + neostigmine(R + N) group(n =30).All patients received mi- dazol...