肌松拮抗对麻醉恢复室患者残余阻滞作用的影响

The effect of muscle relaxant antagonismon on patients with residual paralysis in postanesthesia care unit

目的 探讨肌松拮抗药对麻醉恢复室患者残余阻滞作用的影响.方法 从入麻醉恢复室（PACU）患者中选出相似的患者进行配对,分为实验组（J组）和对照组（F组）,每组26例,术后PACU内用四个成串刺激（TOF）监测肌松,TOF为4时J组给予新斯的明40 μg/kg、阿托品20 μg/kg;F组给予5ml生理盐水.按临床指征拔管,记录拔管时的TOF值、PaO2、PaCO2、离开PACU时SpO2、PACU停留时间以及是否出现呼吸抑制和副作用.结果 J组拔管时的TOF值（0.96 ±0.04）明显较F组（0.92±0.06）高（P＜0.05）,PACU停留时间[（26 ±5）min]也短于F组[（33±7）min]（P ＜0.01）.F组有2例出现呼吸抑制.拔管时的PaO2及PaCO2、拔管时间、离开PACU的SpO2两组差异无统计学意义（P＞0.05）.两组患者均未出现术后恶心呕吐（PONV）等副作用.结论 常规肌松拮抗使术后残余肌松作用风险降低,缩短PACU停留时间,且无PONV等副作用.

Objective To investigate the effects of muscle relaxant antagonism on patients with residual paralysis in postanesthesia care unit （PACU）. Methods The similar patients who were daily accepted into PACU were chosen to make pairs, and were randomly divided into experimental （J; n =26） and control （F; n =26） groups. On arrival to the PACU, the train-of-four ratio （TO- Fr） was assessed using electromyogrhphy. When TOFr reached 4, Grour J was given with neostigmine 40 ug/kg and atropine 20 ug/ kg; Group F was given with 5ml saline. Extubation was determined with standard clinical criteria. We recorded TOFr, PaO2, PaCO2 at the time point of extubation, SpO2 at the time point of left the PACU, the stay time in PACU, the incidence of respiratory dysfunction, and the side effect. Results The TOFr at the time point of extubation in group J （0. 96 ±0. 04） was significantly higher than group F （0. 92±0. 06） （ P 〈0. 05）. The stay time in PACU in group J [ （26 ±5）min] was significantly less than group F [ （33 ± 7）min] （ P 〈0. 01）. PaO2, PaCO2, extubation time, and SpO2 were no significant difference between two groups （ P 〉0. 05）. Two patients in group F had respiratory dysfunction： There was no incidence of postoperative nausea, vomiting, and other side effects in two groups. Conclusions Regular muscle relaxant antagonism lowered the risk of postoperative residual muscle relaxant effect, shortened the PACU residence time, and had no postoperative nausea and vomiting（PONV） and other side effects.