残余肌松对全麻患者术后拔管早期呼吸功能的影响

The impact of residual neuromuscular blockade on respiratory function during early period of post-extubation in patients undergoing general anesthesia

目的观察术后残余肌松发生率及其对全麻患者术后拔管早期呼吸功能的影响。方法选择择期全麻手术患者124例,术前测定肺功能,术毕保留气管内导管转入麻醉后恢复室(PACU)。根据临床征象判断拔管,测定拔管后患者拇内收肌TOFr及拔管后10、40min的肺功能。根据TOFr,将患者分为无残余肌松组(NR组,TOF≥0.9)和残余肌松组(R组,TOF<0.9),对两组患者肺功能指标进行比较。结果 124例患者中,NR组78例,R组46例,术后残余肌松发生率为37.1%。NR组和R组患者术前肺功能差异无统计学意义。拔管后10min,NR组的用力肺活量(FVC)、一秒钟用力呼气容积(FEV1)、最大通气量(MVV)分别可恢复至术前的(65.6±17.7)%、(63.3±18.4)%和(62.2±17.4)%,R组可恢复至术前的(56.1±17.6)%、(52.2±16.4)%和(53.3±15.9)%,NR组恢复程度显著优于R组(P<0.05)。拔管后40min,NR组患者的FVC、FEV1、MVV可恢复至术前的(73.3±16.0)%、(72.3±18.9)%和(72.2±17.2)%,R组可恢复至术前的(66.1±17.9)%、(61.3±17.1)%和(61.8±17.4)%,NR组恢复程度显著优于R组(P<0.05)。结论依据临床征象判断拔管的患者,拔管后残余肌松发生率较高,且拔管后早期呼吸功能明显受损。

Objective To determine the incidence of residual neuromuscular blockade in patients undergoing general anesthesia who were extubated by clinical evaluation,to evaluate the impact of postoperative residual neuromuscular blockade on respiratory function during early period of post-extubation in these Patients. Methods One hundred and twenty-four patients （ASA I or II） undergoing general anesthesia were enrolled. Pulmonary function were monitored preoperation. Extubation of the intratracheal tube in PACU was performed under clinical criteria. Train-of-four ratios（TOFr） were immediately measured using acceleromyography after extubation. We divided these patients into two groups （Group NR and Group R） according to the value of TOFr. NR means the non-residual neuromuscular blockade group （TOF≥0.9）and R means the residual neuromuscular blockade group（TOF0.9）. Pulmonary function were monitored in the 10 min and 40 min after extubation.Results There were 78 cases enrolled in NR group,46 cases enrolled in R group. The incidence of residual neuromuscular blockade was 37.1% in these patients. There was no significant difference of respiratory function in two groups before operation. Compared with the recovery rate to the values of preoperation,the values of forced vital capacity （FVC）（56.1±17.6）%,forced expiratory volume in 1（FEV1）（52.2±16.4）% and maximal voluntary ventilation（MVV）（53.3±15.9）% in R group are less than those in NR group（65.6±17.7）%,（63.3±18.4）%,（62.2±17.4）% at 10 min post-extubation（P0.05）. Compared with the recovery rate to the values of preoperation,the values of FVC（66.1±17.9）%,FEV1 （61.3±17.1）%and MVV （61.8±17.4）% in R group are less than those in NR group（73.3±16.0）%、（72.3±18.9）%和（72.2±17.2）% at 40min post-extubation（P0.05）Conclusion There is a relative high incidence of residual neuromuscular blockade would appear according to the routine clinical evaluation of recovery of neuromuscular function,which would impair respiratory function during early period of post-extubation.