神经外科术中应用顺式阿曲库铵行定量肌松的研究

Anesthetic Effects on Partial Neuromuscular Blockade with Continuous Cisatracurium Infusion in Neurosurgery

目的探讨神经外科手术中吸入七氟烷麻醉和丙泊酚静脉靶控输注(TCI)麻醉两种背景下使用顺式阿曲库铵实现稳定部分肌松时的给药特点。方法 40例行神经外科手术的病例随机分为七氟醚组(七氟烷吸入麻醉,术中七氟烷1.0MAC维持麻醉)和丙泊酚组(丙泊酚,静脉TCI麻醉,术中丙泊酚血浆靶浓度4μg.mL-1维持麻醉)。同时术中持续输注顺式阿曲库铵,根据肌松监测结果调整其输注速率,维持2 h以上4个成串刺激(TOF)计数为2的稳定目标肌松程度。结果两组患者均可实现2 h以上TOF计数为2的稳定肌松程度。但丙泊酚组中有2例患者在此肌松程度下发生体动;在达到稳定目标肌松程度后,顺式阿曲库铵输注速率随时间延长而不同程度降低。结论在长时间神经外科手术中应用七氟烷吸入麻醉或丙泊酚静脉TCI麻醉及连续输注顺式阿曲库铵可以维持稳定的部分肌松程度,其输注速率随麻醉时间(<120 min)延长而逐渐降低。

Aim To investigate the infusion characteristics of cisatracurium when maintaining a long-time stable level of partial neuromuscular blockade （NMB） under sevoflurane-based or propofol TCI-based anesthesia in neurosurgery. Methods 40 patients undergoing neurosurgery were randomly assigned to receive a sevoflurane-based （sevoflurane group） or propofol TCI-based anesthesia （propofol group）. Anesthesia was maintained with 1.0 MAC sevoflurane in sevoflurane group while target concentration of propofol was set at in propofol group. Intraoperative continuous infusion of cisatracurium was performed. Infusion rate was titrated according to the NMB monitoring results to maintain a stable target NMB level （count of 2 of train of four, TOF）. Results All the forty patients could achieve a stable NMB level of count of 2 in TOF mode for more than 2 hours, however, unexpected body movements were seen in two patients in Group P at such NMB level. Both of groups showed a progressive decrease in infusion requirements in two hours. Linear correlation between infusion rates and the time was found in both of groups. Conclusion In prolonged neurosurgery with either sevoflurane-based or propofol-based anesthesia, linear correlation between infusionrates and the time （〈120 rain） was seen when mamtmnlng a stable NMB level ot count ot 2 m 10b mode under continuous cisatracurium infusion.