气腹对闭环肌松输注罗库溴铵量效的影响

Effect of Pneumoperitoneum on the Closed-Loop Muscle Relaxants Rocuronium Infusion of Dose-Effect

目的：探讨CO2气腹对闭环肌松输注罗库溴铵量效的影响。方法选择全麻下行胃癌根治术患者60例，年龄50～64岁，ASAⅠ～Ⅱ级。根据手术方式分为开腹组（ O组）和气腹组（ P组）。两组患者采用咪达唑仑、舒芬太尼、丙泊酚TCI、罗库溴铵麻醉诱导，罗库溴铵采用闭环肌松输注系统（ CLMRIS-I），用T1计数模式进行肌松监测并且闭环输注。气管插管后，行机械通气。两组持续靶控输注丙泊酚，间断追加舒芬太尼。分别记录两组在术前、手术开始0．5h，1h，2h，3h的呼末二氧化碳分压（ PET CO2）及动脉血二氧化碳分压（PaCO2）。记录罗库溴铵的起效时间、肌松恢复情况及用药总量等指标。结果两组间年龄、性别、体重指数、起效时间、血流动力学变化的差异均无统计学意义（P＞0．05）。与O组相比，P组T125％时间延长（P＜0．05）、恢复指数（RI）时间延长（P＜0．05）、TOFr25％恢复时间延长（P＜0．05）、用药总量减少（P＜0．05）。结论 CO2气腹下腹腔镜胃癌根治术罗库溴铵的作用时间延长，用药量减少，但对其起效时间无影响。

Objective To study the impact of CO2 pneumoperitoneum on the closed-loop muscle relaxants rocuronium infusion. Methods Sixty patients with radical operation of gastric cancer under general anesthesia,aged 50 to 64 years and ASA Ⅰ-Ⅱ level,were selected.They were divided into open group（O group） and pneumoperitoneum group（P group） according to the operation methods.Two groups of patients used midazolam,sufentanil,propofol TCI,rocuronium to induct anesthesia.Rocuronium was infused with closed-loop muscle relaxants system（CLMRIS-I）,muscle relaxants T1 counting mode was used to monitor and closed-loop infuse.After tracheal intubation,me-chanical ventilation was conducted.Two target controlled infusion of propofol,sufentanil intermittent chase.The exhalation of carbon dioxide partial pressure（PETCO2） and arterial carbon dioxidepartial pressure（PaCO2） in the two groups were recorded at the preoperative,and 0.5h, 1h,2h,3h during theoperation.Rocuronium onset time,the total dose of muscle relaxant drugs and other indicators were recorded.Results The difference of age,sex,body mass index and onset time between the two groups was not statistical significant（P〉0.05）.Compared with the O group,T1 prolonged,recovery index（RI）,the recovery time of TOFr 25% and the total amount of medication in P group were all re-duced.Conclusion Rocuronium prolongs duration of action,reduces the dosage,but has no effect on the onset time in CO2 pneumoperitone-um laparoscopic radical gastrectomy.