经皮肾镜手术中体温对不同年龄患者顺式阿曲库铵恢复时间的影响

Impact of body temperature on muscle recovery of cisatracurium for percutaneous nephrolithotomy patients of various ages

目的观察不同年龄患者在经皮肾镜手术中体温的变化及体温对顺式阿曲库铵恢复时间的影响。方法选择ASAⅠ~Ⅱ级经皮肾镜手术患者80例，随机分为两组，N组为术中不保温组，H组为术中保温组。再根据年龄将每组患者再分两组，分别为不保温中青年组（ NY组）、不保温老年组（ NO组）、保温中青年组（ HY组）、保温老年组（ HO组），每组各20例。采用全身麻醉顺式阿曲库铵0.15 mg/kg诱导气管插管，持续监测肌肉松弛和鼻咽温度，并记录起效时间、拇肌诱导肌颤搐反应（T1）恢复至25%、75%的时间和完全恢复时间（TOFr0.9）及恢复指数（RI）。结果 术毕两个不保温组体温显著低于两个保温组（ P ﹤0.05），且不保温老人组体温[（34.7±0.4）℃]低于不保温成人组[（35.2±0.3）℃]（P﹤0.05）；两个不保温组患者的T125%、75%、RI时间明显长于保温组（ P﹤0.05），不保温老人组起效时间、T125%、75%时间长于不保温成人组（P﹤0.05）。结论经皮肾镜手术容易发生术中低体温，保温有助于顺式阿曲库铵肌肉松弛作用的恢复，高龄患者尤其应注意保温，避免肌松药残留引起术后并发症。

Objective To investigate the temperature changes and the muscle recovery of cisatra-curium for percutaneous nephrolithotomy（ PCNL）patients of various ages. Methods A total of 80 PNCL patients with ASAⅠ~Ⅱ grade were randomly divided into two groups,including H group with heat pre-serving and N group without heat preserving. Then each group was divided into two subgroups according to different ages. The four groups were young non-heat preserving group（ NY group）,old non-heat preserving group（ NO group）,young heat preserving group（ HY group）and old heat preserving group（ HO group）. Each group enrolled 20 patients. All patients received general anesthesia and intubation was conducted with 0. 15 mg/kg of cisatracurium. The nasopharyngeal temperature and muscle relaxation parameters were recorded during the whole procedure,including the onset time,duration of T1 to 25% and 75%,recovery index（ RI）and duration of TOFr to 90%. Results Patients in the non-heat preserving groups had lower body temperature compared with the heat preserving groups at the end of the surgery（P﹤0. 05）;the body temperature of the NO group[（34. 7 ± 0. 4）℃]was significantly lower than the NY group[（35. 2 ± 0. 3）℃]. The durations of T1 to 25%,T1 to 75%,TOFr to 90%,and RI of non-heat preserving groups were longer compared with the heat preserving groups（P﹤0. 05）;compared with the NY group,the NO group had longer durations of onset time,T1 to 25%,and T1 to 75%. Conclusion Hypothermia often oc-curs in PCNL,and heat preserving is very helpful to the recovery of muscle relaxation. More attention in heat preserving should be paid in elderly patient,which prevents the postoperative complications caused by residual muscle relaxants.