残余肌松与全麻术后呼吸功能不全关系的临床研究

The effect of postoperative residual paralysis on respiratory dysfunction

目的了解全麻手术后在麻醉恢复室（postanesthesia care unit，PACU）内呼吸功能不全的发生率，并评估其与残余肌松的关系。方法择期全麻手术成年患者623例，术后PACU内用4个成串刺激（TOF）监测肌松，按临床指征拔管，根据拔管后即刻测量TOF值将患者分成3组，TOF〉0．9为A组；TOF0．7—0．9为B组；TOF〈0．7为C组，记录每组出现呼吸功能不全的例数。结果全麻手术后在PACU内呼吸功能不全的发生率为4．5％，A组患者472例，其中有7例（1．5％）出现呼吸功能不全，B组患者112例，9例（8．0％）出现，C组患者39例，有12例（30．8％）出现，最常见的是低氧血症和上呼吸道梗阻。c组与A组和B组比较及B组与A组比较，出现呼吸功能不全比例明显增高（P〈0.01）。结论存在残余肌松（TOF〈0．9）的患者更易出现术后呼吸功能不全，应加强围手术期肌松监测，掌握恰当的拔管时机。

Objective To determine the incidence of respiratory dysfunction after general aneasthesia in postanesthesia care unit （PACU） and access its relationship with residual paralysis. Methods 623 adult patients, scheduled for elective surgical procedures, were enrolled in the study. On arrival to the PACU, the train-of-four ratio was assessed using electromyography. Extubation was determined using standard clinical criteria. Patients were divided into three groups according to the TOF measured after extubation, group A （TOF〉 0.9）; group B （TOF 0.7-0.9）; group C （TOF〈0.7）. The number of patients who have respiratory dysfunction were recorded in each group. Results The incidence of respiratory dysfunction after general aneasthesia in PACU is 4.5%. There were 7（1.6%）, 9（8.0%）, and 12（30.8%） patients who had respiratory dysfunction in the groups A, B, C respectively. The most common complications are hypoxemia and airway obstruction. The incidence of respiratory insufficiency in the group C is significant higher than in the groups A and B,and it is significant higher in the group B than in the group A. Conclusions Patients with residual paralysis （TOF〈0.9） are more likely to have postoperative respiratory dysfunction and should be given neuromuscular monitoring perioperatively. The timing of extubation is very important.