新斯的明拮抗老年患者术后肌松药残留阻滞作用的量效研究

Dose-effect relationship study of Neostigmine antagonizing Cisatracurium residual paralysis in elderly patients after surgery

目的：研究老年患者术后使用新斯的明拮抗顺式阿曲库铵肌松药残留阻滞作用的量效关系。方法选择深圳市第二人民医院2013年2-9月在全凭静脉麻醉下行腹腔镜胆囊摘除术的老年患者80例，分为4组，每组各20例，即T0，T5，T10和T20组。术后当4个成串刺激比值（TOFR）恢复至0.5时，T5，T10和T20组患者分别静脉注射新斯的明5，10，20μg/kg，而T0组注射生理盐水。记录TOFR恢复到1.0的时间，记录给药前及给药后第3、5、10分钟的心率（HR），血压（BP）的变化，计算各组10min内TOFR成功恢复到1.0的百分率，以及术后6h恶心呕吐的发生率。结果①T0组比较，T20组TOFR恢复到1.0时间明显缩短，T20组中10min内TOFR成功恢复到1.0的百分率增加，差异有统计学意义（P〈0.05）；而T5组及T10组在TOFR恢复到1.0时间以及10min内TOFR成功恢复到1.0的百分率与T0组比较，差异无统计学意义（P〉0.05）。②T20组在第3、5、10分钟的HR与给药前比较明显降低，差异有统计学意义（P〈0.05）。T0组、T5组及T10组在给药前后HR变化差异无统计学意义（P〉0.05），各组给药前后BP变化差异无统计学意义（P〉0.05）。③各组术后6h恶心呕吐发生率差异无统计学意义（P〉0.05）。结论在老年患者腹腔镜胆囊切除术后，当TOFR恢复至0.5时，使用20μg/kg新斯的明可有效的拮抗顺式阿曲库铵的残留作用，20μg/kg剂量新斯的明可导致老年患者心率减慢，但不增加术后恶心呕吐发生率。

Objective To investigate the dose-effect relationship of neostigmine to antagonize Cisatracurium residual paralysis after surgery in elderly patients. Methods From February to September 2013, in the Second People＆#39;s Hospital of Shenzhen City, 80 elderly patients with scheduled for elective laparoscopic cholecystectomy under total intravenous anesthesia were selected, and devided into 4 groups post operation, 20 cases in each group. Patients in T5 group, T10 group and T20 group were given 5, 10, 20μg/kg Neostigmine respectively, while T0 group was given saline, when Train-Of-Four Ratio （TOFR） returned to 0.5 after surgery. Time to TOFR 1.0, blood pressure （BP） and heart rate （HR） before administered and at the end of 3, 5,10 min after administered were recorded. The ratio of successful reversal within 10 min and postoperative nausea and vomiting after 6 h of each group were calculated. Results①Compared with T0 group, the time to TOFR 1.0 of T20 group was significantly short, and the ratio of successful reversal to TOFR 1.0 within 10 minutes of T20 group was increased, the differences were statistically significant （P 〈 0.05）, while compared with T0 group, the time to 1.0 and the ratio of successful reversal of T5 group and T0 group, the differences were not statistically significant （P〉0.05）.②HR of T20 group was significantly lower at the end of 3,5 and 10 min after administered com-pared with before administered, the differences were statistically significant （P〈 0.05）. There was no statistical differ-ence of HR of T0 group,T5 group,and T10 group between before and after administered （P〉 0.05）. There was no statisti-cal difference of BP of each group between before and after administered （P〉0.05）.③There was no statistical differ-ence of PONV of each group after 6 h （P 〉 0.05）. Conclusion For successful reversal the residual paralysis of cisatracurium within 10 minutes after laparoscopic cholecystectomy surgery in elderly, 20μg/kg neostigmine is needed when given at TOFR 0.5. 20 μg/kg of neostigmine is associated with lower heart rate in elderly patients, but does not increase the incidence of PONV.