肌松监测下罗库溴铵气管插管时机的临床研究

The timing of tracheal intubation with rocuronium relaxation based on neuro-muscular monitoring

目的比较肌松监测下静脉注射罗库溴铵0．9mg／kg后60秒和4个成串刺激（train—of—four，TOF）的T1达到最大抑制程度时的气管插管条件，探讨该药理想的气管插管时机。方法120例行择期腹腔镜胆囊切除术患者，年龄18岁-60岁，ASAⅠ～Ⅱ级，随机均分为两组，分别于静脉注射罗库溴铵0．9mg／kg后60秒（A组）或T1达到最大抑制程度时（B组）行气管插管。观察并记录两组罗库溴铵起效时间（TOF的T1达到最大抑制程度的时间）、气管插管条件（Cooper＇s评分）、声门暴露程度（Cormack-Lehane分级）、诱导过程中的心率（heartrate，HR）和收缩压（systolic blood pressure，SBP）变化以及术后24h咽喉并发症（喉痛、声嘶等不适）。结果静注罗库溴铵0．9mg／kg后66．0秒±18．1秒（95％可信区间30．2秒～101．8秒）达到T1最大抑制。B组Cooper＇s评分和Cormack．Lehane分级均优于A组（P〈0．05）。插管后两组HR和SBP较插管前明显升高（P〈0．05），A组SBP升高程度大于B组（P〈0．05）.两组术后声嘶发生率差异无统计学意义，A组咽喉疼痛发生率显著高于B组（P〈0．05）。结论静脉注射罗库溴铵0．9mg／kg后T1达到最大抑制程度时比给药后60秒时的气管插管条件更满意，罗库溴铵0．9mg／kg理想的气管插管时机是给药101．8秒后。

Objective To investigate the timing of tracheal intubation with rocuronium relaxation based on neuro-muscular monitoring. Methods One hundred and twenty patients undergoing elective laparoscopic cholecystectomy were randomly divided into two groups （n=60）. Tracheal intubation performed 60 s after a bolus dose of 0.9 mg/kg rocuronium （group＇ A） or at maximal T1 depression based on neuromuscular monitoring （group B）. Glottic exposure and intubation condition were evaluated with Cormack-Lehane classification and Cooper＇s score, respectively. HR, SBP and time to maximal T1 depression were recorded during induction. Hoarseness and sore throat were observed in first postoperative day. Results Time to maximal T1 depression after rocuronium injection was （66.0±18.1 ）s （95 % confidence interval 30.2 s- 101.8 s）. Cooper＇s score and Cormack＇s classification in group B was superior to that in group A （P〈0.05）. HR and SBP increased significantly after tracheal intubation（P〈0.05） in both groups, with more increasing extent in group A（P〈0.05）. The incidence of hoarseness was comparable between both groups, with higher incidence of sore throat in group A than in group B（P〈0.05）. Conclusion Neuro-muscnlar monitoring enables to get better intubation condition. More than 101.8 s after a bolus dose of 0.9 mg/kg rocuronium may be the ideal time for tracheal intubation.