体温对罗库溴铵残余肌松恢复和拮抗效果的影响

Effect of intraoperative warming on recovery and antagonism of rocuronium-induced residual neuromuscular blockade

目的观察术中保温对罗库溴铵肌松恢复和残余肌松拮抗效果的影响。方法将40例择期在全身麻醉下行手术的患者随机分为4组:术中不保温和术后肌松自然恢复组(Ⅰ组),术中不保温和术后残余肌松拮抗组(Ⅱ组),术中保温和术后肌松自然恢复组(Ⅲ组),术中保温和术后肌松拮抗组(Ⅳ组)。予丙泊酚、芬太尼和0.6mg/kg罗库溴铵诱导气管插管,术中使用4个成串刺激(TOF)-WatchSX监测,TOF中第1个肌颤搐出现的时间(T1)恢复至0.25时给予罗库溴铵0.15mg/kg。Ⅲ组、Ⅳ组采用热毯加覆盖法保持体温。手术结束后当TOF中第4个肌颤搐与第1个肌颤搐的比值(TOFR)恢复至0.6,Ⅱ组、Ⅳ组给予新斯的明0.015mg/kg和阿托品0.5mg拮抗肌松,Ⅰ组、Ⅲ组让肌松自然恢复。结果Ⅲ、Ⅳ组的术毕体温显著高于Ⅰ、Ⅱ组(P值均<0.05)。对于术后拮抗的患者,Ⅳ组的TOFR恢复时间为(15.5±2.6)min,显著短于Ⅱ组的(6.3±2.0)min(P<0.05);对于术后不拮抗的患者,Ⅲ组的TOFR恢复时间为(15.5±2.6)min,显著短于Ⅰ组的(19.5±6.3)min(P<0.05)。对于术中保温的患者,Ⅳ组的TOFR恢复时间显著短于Ⅲ组(P<0.01);对于术中不保温的患者,Ⅱ组的TOFR恢复时间显著短于Ⅰ组(P<0.01)。结论术中保温有助于患者术后罗库溴铵残余肌松的恢复和拮抗。

Objective To investigate the effects of intraoperative warming on the recovery from rocuronium-induced postoperative residual neuromuscular blockade and the antagonism effect of small dose of neostigmine.Methods Forty patients receiving elective surgery were randomly divided into four groups：groupⅠ,without warming and allowing spontaneous recovery of rocuronium-induced neuromuscular blockade;group Ⅱ,warming and allowing spontaneous recovery;group Ⅲ,without warming,but the residual neuromuscular blockade was antagonized with small dose of neostigmine;and group Ⅳ,warming and antagonized with small dose of neostigmine（n=10 each）.General anesthesia was induced with propofol,fentanyl and rocuronium 0.6 mg/kg.The neuromuscular transmission was monitored by train-of-four（TOF）-Watch SX acceleromyograph.Rocuronium was given when T1 recovered to 0.25.Patients were covered and electric blanket was used for warming group.The residual neuromuscular blockade was antagonized with atropine（0.5 mg）and neostigmine（0.015 mg/kg）in the antagonism group when the train-of-four ratio（TOFR）reaching 0.6.The intervals of TOFR recovering from 0.6 to 0.9 were recorded.Results After operation,the body temperature of group Ⅲ and Ⅳ was significantly higher than those of the other two groups（all P0.05）.The TOFR recovery interval was（15.5±2.6）min in Ⅳ group,which was significantly shorter than that in group Ⅱ（6.3±2.0）min（P0.05）;significant difference was also found in the recovery intervals between group Ⅱ and Ⅳ（[15.5±2.6] min vs.[19.5±6.3] min,P0.05）.The recovery in antagonizing groups was much faster than those in the spontaneous groups（P0.01）.Conclusion Intraoperative warming is favorable for spontaneous recovery and antagonizing from postoperative rocuronium-induced neuromuscular blockade.