不同剂量维库溴铵用于麻醉诱导对甲状腺手术患者术中喉返神经监测的影响

Effect of vecuronium at different doses for induction of anesthesia on monitoring of recurrent laryngeal nerve in patients undergoing thyroid operation

目的 评价不同剂量维库溴铵用于麻醉诱导对甲状腺手术患者术中喉返神经监测的影响.方法 择期甲状腺手术患者117例,性别不限,年龄20 ～ 64岁,体重50 ～ 85 kg,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将其分为3组：Ⅰ组（n=39）、Ⅱ组（n=40）和Ⅲ组（n=38）.依次静脉注射咪达唑仑2 mg、异丙酚2 mg/kg、舒芬太尼0.5 μg/kg,BIS值达40 ～ 50后,Ⅰ组静脉注射维库溴铵0.05mg/kg,Ⅱ组静脉注射维库溴铵0.10 mg/kg,5 min后插入喉返神经监测专用气管导管;Ⅲ组吸入七氟醚,呼气末浓度达到4％时插入喉返神经监测专用气管导管.气管插管术后行机械通气,吸入七氟醚维持麻醉.记录气管插管条件评分;于手术30 min时,每隔5 min直到手术70 min采用神经肌电监测仪监测喉返神经诱发的肌电位.结果 虽然3组气管插管成功率均为100％,但Ⅰ组和Ⅱ组气管插管条件明显优于Ⅲ组（P＜0.05）,而Ⅰ组与Ⅱ组间比较差异无统计学意义（P＞0.05）.与Ⅲ组比较,虽然Ⅰ组各时点肌电位降低（P＜0.05）,但诱发肌电信号可满足监测要求;Ⅱ组手术30 min期间诱发肌电信号缺失,手术35 ～ 45 min时仍未获得有效信号.结论 1倍ED95维库溴铵用于甲状腺手术患者麻醉诱导不仅有助于提供满意的气管插管条件,而且对术中喉返神经监测无明显影响,可作为该类手术麻醉诱导的适宜剂量.

Objective To investigate the effect of vecuronium at different doses for induction of anesthesia on monitoring of recurrent laryngeal nerve in patients undergoing thyroid surgery.Methods One hundred and seventeen patients,ASA Ⅰ or Ⅱ,aged 20-64 yr,weighing 50-85 kg,scheduled for thyroid surgery,were randomly divided into three groups：group Ⅰ （n =39）,group Ⅱ （n =40） and group Ⅲ（n =38）.Anesthesia was induced with midazolam 2 mg,propofol 2 mg/kg,sulfentanil 0.5 μg/kg.Following BIS value at 40-50,vecuronium 0.05（ED95） or 0.10 mg/kg （2 × ED95）was intravenously injected in group Ⅰ or Ⅱ respectively,and the electromyographic （EMG） endotracheal tube was intubated under glidescope at 5 min after vecuronium administration.Group Ⅲ received sevoflurane inhalation and the EMG endotracheal tube was intubated following end-tidal sevoflurane concentration at 4%.Anesthesia was maintained with inhalation of sevoflurane in three groups.Cooper＇ s score and the success of attempt at endotracheal intubation were recorded.The recurrent laryngeal nerve-evoked EMG response was monitored to record the amplitude at 5 min intervals from 30 min to 70 min following surgery.Results The success rates of endotracheal intubation were 100% in three groups,but the Cooper＇ s score of groups Ⅰ and Ⅱ was significantly higher than that of group Ⅲ （P 〈 0.05）,while there was no significant difference between groups Ⅰ and Ⅱ.In spite of the EMG amplitude being significantly decreased as compared with group Ⅲ,the EMG response was adequate for monitoring of recurrent laryngeal nerve in group Ⅰ.The EMG response was lost 30 min following surgery,and inadequate for neuromonitoring of recurrent laryngeal nerve 35-45 min following surgery in group Ⅱ.Conclusion Vecuronium 0.05 mg/kg （ED95）for induction of anesthesia may be helpful to provide satisfactory endotracheal intubation conditions,also not affect the monitoring of recurrent laryngeal nerve in patients undergoing thyroid surgery,which can be recommended as the optimal dosage.