麻醉恢复室患者残余肌松阻滞作用的拮抗

Reasonable reversal of neuromuscular block in the postanesthesia care unit

目的对麻醉恢复室(PACU)患者采用不同剂量新斯的明拮抗维库溴铵残余肌松阻滞(RNMB),观察能否缩短复苏时间及其理想剂量和效果。方法选择60例择期在气管内全麻下行胃肠手术的患者,术毕转入PACU后监测四个成串刺激比值(TOFR)来评定RNMB程度。当T1恢复至0.25时,患者随机分为N1,N3,N5和对照组N0组。N1,N3,N5组分别给予新斯的明10,30,50μg.kg-1和阿托品5,15,25μg.kg-1;对照组(N0组)静脉注射等容积生理盐水。分别记录注药后T1恢复至0.75的时间(恢复指数,RI)、TOFR恢复至0.7和0.9的时间、患者PACU留驻时间(T),以及病人给药后5 min内HR和BP变化并观察术后有无恶心呕吐的发生。结果不同剂量的新斯的明皆能明显加快RI和TOFR恢复至预定值的时间,并缩短PACU留驻时间(P<0.05)。与N1组比较,N3和N5组RNMB消除快,病人在PACU留驻时间缩短(P<0.05)。N5组较N3组RI和TOFR恢复至0.7的时间缩短(P<0.05)。术后各组病人恶心呕吐(PONV)发生率比较无统计学意义(P>0.05)。N3组、N5组在给药后1～2 min内HR明显加快(P<0.05),但MAP无明显变化(P>0.05);N0组与N1组的各时点HR和MAP比较差异不明显(P>0.05)。结论全麻术后转入PACU患者给予10～50μg.kg-1新斯的明合并5～25μg.kg-1阿托品均能有效拮抗维库溴铵的RNMB,并能有效缩短PACU留驻时间,且小剂量的新斯的明(10μg.kg-1)和阿托品(5μg.kg-1)联合应用对血流动力学干扰小。

Aim To evaluate the antagonistic dose-effect and safety of neostigmine on vecuronium-induced residual neuromuscular blockade.Methods Sixty patients scheduled for a gastrointestinal surgery under general anesthesia were induced with midazolam,fentanyl,etomidate and vecuronium during general anesthesia,and were maintained with propofol and remifenfanil.The dose of vecuronium were injected as clinically required during surgery.The train-of-four ratio（TOFR） was monitored by acceleromyography.When TOFR recovered to 0.25,patients in Nl group,N3 group and N5 group were administrated neostigmine（10,30,50 μg·kg-1） and atropine（5,15,25 μg·kg-1） respectively,and those in control group（N0 group） were intravenously injected with 2 mL normal saline.The time of RI,TOFR recovery to 0.7 and 0.9 was monitored,the length of stay in the PACU（T）,heart rate and blood pressure were recorded,and postoperative nausea and vomiting were also observed.Results Neostigmine significantly accelerated the recovery of RI,TOFR and the length of stay in the PACU（P0.05）.The time of recovery and the length of stay in the PACU in N3 group and N5 group was significantly less than that in N1 group（P0.05）.There was no significant difference in the incidence of postoperative nausea and vomiting among each group（P0.05）.The heart rates in N3 group and N5 group were significantly increased one to two minutes after administration（P0.05）,while there was no significant difference in blood pressure among each group（P0.05）.Conclusion Three groups of different doses of neostigmine may antagonize vecuronium-induced residual neuromuscular blockade effectively,and lower dose of neostigmine（10 μg·kg-1） is recommended.