大面积烧伤患者多次削痂植皮麻醉时肌松药用量的临床研究

Clinical research on quantity of muscle relaxant for extensive burn patients during crust excision and skin grafting

目的:探讨大面积烧伤患者的主要病理生理变化及肌松药在该类患者中的临床应用。方法:对50例大面积(>30%)烧伤患者,根据植皮次数分别分为第1、2、3次植皮组,观察其手术时维库溴铵的用量、肌松效应、气管插管条件分级以及血流动力学改变,并与同期50例骨伤科患者以上指标进行组内及组间比较。结果:烧伤组削痂时及各次植皮所用药量均显著大于骨伤组(P<0.05),而烧伤组组内药量比较差异均无统计学意义(P>0.05)。烧伤组削痂时及各次植皮所用肌松药起效时间显著大于骨伤组(P<0.05),维持时间、恢复指数均少于骨伤组(P<0.05),气管插管条件均较骨伤组差(P<0.05)。麻醉后烧伤组、骨伤组MAP均明显下降,下降幅度烧伤组较骨伤组明显,烧伤组SpO2明显下降,骨伤组则无明显变化,烧伤组HR无明显变化,骨伤组则下降明显。结论:大面积烧伤患者血流动力学不稳定,其削痂植皮手术时肌松药用量增大,肌松效应减少,气管插管条件降低,需要更高的麻醉要求。

Objective： To investigate the main physiological changes on the severe burn patients and the clinical applications of muscle relaxant in these patients.Methods： 50 severe burn（30%） patients were divided into three groups by their skin graft frequencies： skin graft group 1,2,3.The dosage of Vecuronium Bromide,neuromuscular blocking effect,classification of conditions of endotracheal intubation and hemodynamic changes were observed during the operation and the parameters above were made comparisons in each group and between the groups with 50 bone injured patients in the same period.Results： The drug dosages of the severe burn groups in eschar shaving and each skin graft were far more than the bone injured groups（P0.05）,there was no significant difference（P0.05）;the onset time of muscle relaxant of the severe burn groups in eschar shaving and each skin graft were far more than the bone injured groups（P0.05）,the maintain time and recover index were less than the bone injured groups（P0.05）,and the tracheal intubation conditions were poor than the bone injured groups（P0.05）.After anaesthesia,the MAP of the severe burn groups and bone injured groups had an obvious decrease.And the descending extent of the severe burn groups was more obvious than the bone injured groups;the SpO2 of the severe burn groups had an obvious decrease,while the bone injured groups had no significant change;the HR of the severe burn groups had no significant change,but the bone injured groups had descended obviously.Conclusion： The hemodynamic changes of the severe burn patients are not stable,and the crust excision and skin grafting of the muscle relaxant dosages have increased and the neuromuscular blocking effect has decreased,the tracheal intubation condition has gone down,and higher anesthesia requirements are needed.