不同剂量罗库溴铵对甲状腺手术喉返神经功能监测的影响

Impacts of different doses of rocuronium on intraoperative recurrent laryngeal nerve monitoring during thyroid surgery

目的观察不同剂量罗库溴铵对甲状腺手术喉返神经（RLN）功能监测的影响。方法择期甲状腺手术患者90例,ASAⅠ或Ⅱ级,随机均分为三组,采用静-吸复合全身麻醉。麻醉诱导：丙泊酚1.5～2.0mg/kg、芬太尼4μg/kg和罗库溴铵0.3mg/kg（A组）、罗库溴铵0.6mg/kg（B组）和罗库溴铵0.9mg/kg（C组）,吸入2%～3%七氟醚维持麻醉。采用TOF监测肌松。观察并记录给药前60s、给药后60s及插管后60s的BP、HR及体动变化、TOF出现第一个、第二个肌颤搐的时间及RLN振幅。结果与给药前60s比较,给药后60sB组和C组HR明显减慢,三组SBP和DBP明显降低（P〈0.05）,气管插管后60sA组HR明显增快,SBP和DBP明显升高（P〈0.05）。与给药后60s比较,气管插管后60s三组HR明显增快,SBP和DBP明显升高（P〈0.05）。与A组比较,气管插管后60sB组和C组HR明显减慢、SBP、DBP明显降低（P〈0.05）,C组术中未监测到RLN例数明显增加、等待时间明显延长（P〈0.05）,B组和C组术中体动例数明显减少、TOF出现第一个肌颤搐时的RLN振幅明显降低（P〈0.05）,三组监测时间、TOF出现第二个肌颤搐时的RLN振幅差异无统计学意义。结论 2倍ED95的罗库溴铵（0.6mg/kg）诱导复合七氟醚麻醉适用于甲状腺手术喉返神经功能的监测。

Objective To observe the impact of different doses of rocuronium on neuromuscular electrical activity of recurrent laryngeal nerve（RLN）during thyroid surgery.Methods Ninety elective thyroid surgery patients,ASA ⅠorⅡ,were randomly assigned into three groups（n=30,each）according the doses of rocuronium：group A（0.3mg/kg）,group B（0.6mg/kg）and group C（0.9mg/kg）.Anesthetic maintenance was performed with 2%-3% sevoflurane.Train of four（TOF）was used for testing muscle relaxant.BP,HR,TOF value,recover time and RNL testing value were recorded respectively.Results Compared with 60 sbefore injection,the HR in group B and C were declined clearly 60 slater after injection（P〈0.05）.At the same time,the SBP and DBP of all patients were declined（P〈0.05）.The DBP,SBP and HR in group A were all rising significantly 60 slater after endotracheal intubation（P〈0.05）.Compared with 60 safter injection,the HR,SBP and DBP of all patients were all rising significantly 60 slater after endotracheal intubation（P〈0.05）.The DBP,SBP and HR in group B and C were all declined 60 slater after endotracheal intubation comparing with group A（P〈0.05）.The number of cases that was not detected RLN were significantly increased In group C and the waiting time extended obviously（P〈0.05）.In group B and group C the case number of body movement were declined obviously during surgery,the amplitude of laryngeal recurrent nerve decreased obviously when the TOF recovery 1.The monitoring time of the three group and the amplitude of laryngeal recurrent nerve when the TOF recovery 2were not statistically significant.Conclusion Two ED95 Rocuronium（0.6mg/kg）combined with sevoflurane anesthesia is feasible for monitoring recurrent laryngeal nerve in thyroid surgery.