非去极化肌松药在老年患者围拔管期的残余肌松效应

Residual Neuromuscular Blockade in Non-depolarization Neuromuscular Blockade on the Aged Patients Undergoing General Anesthesia During Extubation

目的评价3种非去极化肌松药在老年患者围拔管期的残余肌松效应。方法选择2011年10月—2012年12月河北省人民医院拟行全身麻醉择期手术的老年患者150例,采用随机数字表法分为罗库溴铵组(A组)50例、顺式阿曲库铵组(B组)50例及维库溴铵组(C组)50例。患者麻醉诱导前肌松监测仪监测左侧外展前臂尺神经拇内收肌收缩情况,脑电活动监测仪测定脑电双频指数(BIS值)。麻醉诱导,患者入睡肌松监测仪定标后,A组、B组、C组分别静脉注射罗库溴铵、顺式阿曲库铵及维库溴铵。记录各组末次用药至拔管时间、临床时效、恢复指数,记录术毕时(T1)、拔管时(T2)、拔管后30 min(T3)及拔管后1 h(T4)4个成串刺激比值(TOFR)<0.7和TOFR<0.9发生率。结果 3组末次用药至拔管时间、临床时效及恢复指数比较,差异均有统计学意义(P<0.05);与B组比较,A组和C组末次用药至拔管时间、临床时效及恢复指数升高(P<0.05)。3组患者T2、T3、T4TOFR<0.7和TOFR<0.9发生率比较,差异均有统计学意义(P<0.05);与B组比较,A组和C组TOFR<0.7和TOFR<0.9发生率升高(P<0.05)。结论应用顺式阿曲库铵可降低老年患者全身麻醉残余肌松发生率,降低拔管风险。

ObjectiveToobservetheeffectofresidualneuromuscularblockadeinthreedifferentnon-depolarization neuromuscularblockadeontheagedpatientsundergoinggeneralanesthesiaduringextubation.Methods 150patientsaboutto undergo general anesthesia in Hebei General Hospital from October 2011 to December 2012 were randomly divided into rocuroni-um group （group A, 50 cases）, cisatracurium group （group B, 50 cases） and vecuronium （group C, 50 cases） .Muscle re-laxation monitor was used to monitor the muscle contraction in left abducens of forearm ulnar nerve , and brain electrical activity monitor was used to determine the BIS before general anaesthesia .Anaesthesia was induced by rocuronium , cisatracurium and ve-curonium in group A, B and C respectively.The time between last drug use and extubation , clinical effect and the index of recov-ery were recorded in each group .The incidence of TOFR〈0.7 and TOFR〈0.9 at the end of operation （ T1 ） , extubation （ T2 ） , 30 min after extubation （ T3 ） and 1 h after extubation （ T4 ） were recorded.Results The time between last time drug use and ex-tubation, clinical effect and the index of recovery in the three groups all showed statistically significant differences （P〈0.05）. Compared with group B , the time between last time drug use and extubation , clinical effect and the index of recovery in group A and group C were increased （P〈0.05） .The incidence of TOFR〈0.7 and TOFR〈0.9 at T2, T3 and T4 all showed statistically significant differences （ P〈0.05 ） .Compared with group B , the incidence of TOFR 〈0.7 and TOFR 〈0.9 in group A and group C were increased （P〈0.05） .Conclusion The application of cisatracurium can reduce the incidence of residual neuro -muscular blockade on the elderly patients undergoing general anesthesia and reduce the risk of extubation .