老年患者全麻术后罗库溴铵的残余作用

Postoperative residual curarization of rocuronium in the elderly

目的观察老年患者全麻术后罗库溴铵的残余效应(PORC)。方法择期全麻手术患者40例,根据年龄分为中青年组和老年组,每组20例。采用静脉复合全麻,罗库溴铵用量为0.9mg/kg。术中用四个成串刺激(TOF)监测肌松,直至拔管后TOF值(TOFr)≥90%。记录各组TOFr从0恢复到25%(临床时效)、从25%恢复到90%的时间,以及拔管时TOFr<90%(PORC)患者TOFr恢复到90%的时间。监测拔管后及TOFr达90%时的动脉血气。结果老年组罗库溴铵作用时效[(60.70±14.27)minvs.(45.51±7.80)min]及TOFr从25%恢复至90%时间[(46.50±11.56)minvs(34.50±9.56)min]均长于中青年组(P<0.05);老年组PORC发生率高于中青年组(15/20vs12/20),PORC持续时间长于中青年组[(26.00±8.43)minvs(17.20±8.00)min](P<0.05);老年组拔管后CO2蓄积例数多于中青年组(13例vs.6例)(P<0.05)。结论老年患者罗库溴铵的PORC发生率高于中青年患者,应加强围手术期肌松监测,掌握恰当的拔管时机。

Objective To study the postoperative residual curarization （PORC） of rocuronium in the elderly. Methods Forty patients, with normal renal hepatic function and without muscle or nerves diseases, were divided into 2 groups of younger group（〈65 years old） and eider group（≥65 years old）. All patients received total intravenous anesthesia with propofol, remifentainyl and roeuronium, Neuromuscular blockade was evaluated with train-of-four（TOF） stimuli of the ulnar nerve during operation. Roeuronium 0.6 mg/kg was given during anesthesia induction. Postoperative neuromuscular blockade was continuously monitored until TOF rate （TOFr） reached 90%. The recovery times of TOFr from 0 to 25%, from 25% to 90%, and from the TOFr less than 90% at tracheal extubation reaching 90% were recorded. The arerial blood gas analysis was performed at the time of TOFr reaching 90 %. Results The times of effect duration and the time of TOFr from 25 % to 90% were （60.70±14.27）minvs. （45.51±7.80）minand（46.50±11.56）minvs. （34.50±9.56） min espectively, which were significantly longer in elder group than those in younger group （P〈 0. 05 ）. The rate of PORC was higher in elder group than that in younger group（15/20 vs. 12/20）, and the duration of PORC was longer in elder group than that in younger group [（26. 00±8. 43） min vs. （17.20±8. 00） mini （P〈0. 05）. The number of COz accumulation after extubation in elder group was more than that in younger group（13 vs. 6）（P〈0.05）. Conclusion The eider patients are at a high risk of PORC and attention should be paid to the evaluation of the neuromuscular blockade and of the proper time of tracheal extubation.