闭环输注罗库溴铵在腹腔镜胆囊切除术中的应用

Study on the Application of Rocuronium Infusion by the Close-loop Muscle Relaxant Injection System in Laparoscopic Cholesystectomy

目的探讨闭环肌肉松弛剂注射系统输注罗库溴铵在腹腔镜胆囊切除术中的可行性和安全性。方法选择2013年6-12月在三峡大学人民医院择期腹腔镜单纯胆囊切除术患者40例,采用随机数字表法分为两组,每组20例。经验组：术中每隔30分钟或根据需要静脉追加罗库溴铵0.15 mg/kg;闭环输注组：采用闭环肌肉松弛剂注射系统自动持续用药。观察诱导前（T0）、插管前（T1）、插管后5 min（T2）、拔管后5 min（T3）时平均动脉压（MAP）及心率;记录苏醒时间、拔管时间、罗库溴铵使用总量、气管插管条件分级、T3时四个成串刺激（TOF）值及不良反应。结果与T0时相比,经验组和闭环输注组患者T1时MAP均下降[经验组：（66±10）mm Hg（1 mm Hg=0.133 k Pa）比（81±10）mm Hg,闭环输注组：（68±9）mm Hg比（81±10）mm Hg];与T1时[心率：经验组（70±8）次/min,闭环输注组（72±10）次/min;MAP：经验组（66±10）mm Hg,闭环输注组（68±9）mm Hg]相比,两组患者T2、T3时MAP[T2：经验组（89±8）mm Hg,闭环输注组（91±11）mm Hg;T3：经验组（83±10）mm Hg,闭环输注组（84±11）mm Hg]及心率[T2：经验组（91±10）次/min,闭环输注组（90±11）次/min;T3：经验组（84±9）次/min,闭环输注组（86±9）次/min]均升高（P〈0.05）;经验组苏醒时间、拔管时间长于闭环输注组[（22±3）min比（16±4）min,（30±5）min比（21±4）min],肌肉松弛剂使用总剂量大于闭环输注组[（53±5）mg比（45±4）mg];T3时TOF值小于闭环输注组[（0.70±0.20）比（0.90±0.20）,P〈0.05]。经验组术中抱怨肌紧张、体动反应及拔管后残余肌肉松弛发生率均高于闭环输注组（P〈0.05）。结论与经验用药法相比,腹腔镜胆囊切除术中使用闭环肌肉松弛剂注射系统输注罗库溴铵安全性更高。

Objective To evaluate the feasibility and safety of rocuronium infusion by close-loop muscle relaxant injection system in laparoscopic cholesystectomy.Methods A total of 40 patients underwent laparoscopic cholesystectomy in People＇s Hospital of Three Gorges University From Jun.2013 to Dec.2013 were randomly divided into two groups according to the random number table method,with twenty cases in each group.In experience group（group E） ：patients were given intravenous injection of rocuronium（0.15 mg/kg） every30 min or when needed,while in close-loop muscle relaxant injection group（group C） ：patients were continously injected with rocuronium by close-loop muscle relaxant injection system.Mean artery pressure（MAP）and heart rate（HR） were monitored before induction（T0）,before intubation（T1）,5 min after intubation（T2） and 5 min after extubation（T3） in both groups.The awakening time,extubation time,total dosages of rocuronium,intubation conditions,train-of-four stimulation（TOF） ratio after extubation and adverse reactions of the two groups were recorded.Results Compared with T0,MAP was decreased at T1 in both groups[group E：（66 ±10） mm Hg（1 mm Hg =0.133 k Pa） vs（81 ±10） mm Hg; group C：（68 ±9） mm Hg vs（81 ±10） mm Hg]（P〈0.05）.Compared with T1[HR：group E（70 ± 8） beat/min,group C（72 ± 10） beat/min;MPA：group E（66 ± 10） mm Hg,group C（68 ± 9） mm Hg],MAP and HR were increased at T2,T3 in both groups[T2MAP：group E（89 ± 8） mm Hg,group C（91 ± 11） mm Hg; T3MAP：group E（83 ± 10） mm Hg,group C（84 ± 11） mm Hg; T2HR：group E（91 ± 10） beat/min,group C（90 ± 11） beat/min; T3HR：group E（84 ± 9） beat/min,group C（86 ± 9） beat/min]（P〈0.05）.Compared with group C,the awakening time and extubation time of group E were extended [（22 ± 3） min vs（16 ± 4） min,（30 ± 5） min vs（21 ±4） min,P〈0.05],the total dosage of rocuronium of group E was more than group C[（53 ± 5） mg vs（45 ±4） mg,P〈0.05],TOF ratio after extubation of group E was lower than group C[（0.70 ± 0.20） vs（0.90 ±0.20）,P〈0.05].The incidences of complaining about muscle tension by operators,body movement response of patients,and residual muscle relaxant effect of rocuronium after extubation in group E were higher than those in group C（P〈0.05）.Conclusion Compared with empirical administration,rocuronium is more safely infused by close-loop muscle relaxant injection system in laparoscopic cholesystectomy.