丙泊酚复合七氟烷麻醉对老年患者全麻术后肌松残余效应的影响

Effects of sevoflurane combined with propofol anesthesias on muscle relaxants residual in elderly patients after general anesthesia

目的探讨丙泊酚复合七氟烷麻醉对老年患者全麻术后肌松残余效应的影响。方法择期行全麻手术的老年患者60例．随机分为两组，每组30例。麻醉诱导后，七氟烷组持续吸入1．5MAC的七氟烷维持麻醉，联合用药组持续泵入丙泊酚4～12mg·kg^-1·h^-1复合0．5MAC的七氟烷维持麻醉，术中脑电双频指数（BIS）值维持在40—60。术中根据四个成串刺激（TOF）肌松监测仪显示第一个肌颤搐（T1）恢复到25％时追加顺阿曲库铵0．05mg·kg^-1。于手术结束前30min停用肌松药，手术结束前10min停止所有麻醉药，术毕不使用肌松拮抗药。记录术中失血量、补液量、麻醉时间、顺阿曲库铵总用量及患者肌松效应恢复情况。结果两组术中失血量、补液量、麻醉时间、顺阿曲库铵总用量均无显著差异（P〉0．05）。与七氟烷组相比，联合用药组患者肌松效应恢复到25％的时间（从停肌松药到T1恢复至25％的时间）缩短、恢复指数（T1从25％至75％的时间）减小，拔管后30min两组残余肌松[四个成串刺激比值（TOFR）〈0．9]发生率降低（P〈0．05），术后3h残余肌松发生率差异无显著意义（P〉0．05）。结论丙泊酚复合七氟烷麻醉可缩短老年患者全麻术后肌松恢复时间，减少残余肌松发生率。

AIM To investigate the effects of sevoflurane combined with propofol anesthesias on muscle relaxants residual in elderly patients after general anesthesia. METHODS Sixty old patients undergoing general anesthesia with ASA I or Ⅱ were randomly divided into two groups （30 patients in each）. After induction of anesthesia, anesthesia was maintained with sevoflurane 1.5MAC in the sevoflurane group and propofol 4 - 12 mg·kg^-1·h^-1 composite sevoflurane 0.5MAC in the combination group. BIS values were maintained at 40 - 60 during operation. Intraoperative cisatracurium （0.05 mg·kg^-1） was given when TOF neuromuscular monitoring showed the first twitch （T1） revert to an additional 25%. Muscle relaxants were disabled 30 min before the end of surgery, and 10 rain before to stop all anesthesia drugs. Muscle relaxant antagonists were not be used in all patients. The amount of intraoperative blood loss, fluid volume, cisatracurium, duration of anesthesia and recovery of muscle relaxant were observed. RESULTS There were no significant difference in the amount of intraoperative blood loss, fluid volume, cisatracurium and duration of anesthesia between two groups （P 〉 0.05）. Compared with the sevoflurane group, the time of muscle relaxant effect recover to 25% （from stop muscle relaxants to T1 recovery to 25%）, recovery index （T1 from 25% to 75% time） and the incidence of residual neuromuscular blockade （TOFR 〈 0.9 the residual muscle relaxant） 30 min after extubation were reduced in the combination group （P 〈 0.05） , while no significant difference in incidence of residual neuromuscular blockade 3 h after operation （P 〉 0.05）. CONCLUSION Sevoflurane combined with propofol anesthesia can reduce recovery time of muscle relaxants and the incidence of residual neuromuscular blockade in elderly patients after general anesthesia.