硬膜外麻醉对快通道结肠外科手术患者罗库溴铵药效的影响

The effect of epidural anesthesia on pharmacodynamics of rocuronium of patient undergone fast track surgery of the colon operation

目的观察硬膜外麻醉对快通道结肠外科患者罗库溴铵药效的影响。方法将40例择期行快速康复腹腔镜结肠手术的患者随机分成两组：A组（全凭静脉麻醉组，术后给予静脉镇痛）和B组（静脉复合硬膜外麻醉组，于19～T10硬膜外穿刺置管，注射0．375％的罗哌卡因10ml后每小时注射6ml上述溶液直至手术结束并用于术后镇痛）。静脉注射0．5μg／kg舒芬太尼后，以3．5mg／L为起始血浆药物浓度靶控输注丙泊酚，以0．1μg／（kg·min）为起始剂量持续输注瑞芬太尼，患者意识消失后注射0．9mg／kg罗库溴铵，当1Hz的单刺激达到最大阻滞时行气管插管。根据Nacotrend指数调整丙泊酚的靶控输注浓度。调整瑞芬太尼的输注剂量，使平均动脉压（MAP）维持在基础值的80％～120％。根据肌松监测结果追加罗库溴铵0．3mg／kg，记录肌松剂的起效时间、作用时间和追加次数。手术结束时停止输注丙泊酚、瑞芬太尼，记录拔管时间。患者于麻醉复苏室（PACU）行肌松监测了解肌松残余情况。结果罗库溴铵的起效时间在两组中差异无统计学意义（P〉0．05）。B组每次追加肌松剂的间隔时间均长于A组，差异有统计学意义（P〈0．05），加药次数少于A组（P〈0．05），拔管时间明显短于A组（P〈0．05）。肌松残余的发生率和持续时间A组均高于B组（P〈0．05）。结论全身麻醉联合硬膜外阻滞在快通道结肠外科麻醉中可延长肌松剂罗库溴铵的作用时间，减少其使用次数；减少肌松残余的发生率和持续时间；提高术后恢复质量。

Objective To evaluate the effect of epidural anesthesia on pharmacodynamics of rocu- ronium of patient undergone fast track surgery of the colon operation. Methods 40 patients undergoing e- lective fast - track＇ colon surgery were enrolled in this study and were randomly allocated to two groups. The patients in group A received total intravenous anaesthesia （TIVA） and postoperative intravenous analgesia. After successful and confirmed epidural catheterization in T9 - T10, patients in group B received 10 ml 0. 375% ropivacaine followed by 6 ml bolous per one hours via the epidural catheter until the end of surger- y, and they received epidural analgesia. Then general anesthesia was inducted with IV 0. 5 I^g/kg sulfen- tanil, taget - controlled infusion （TCI） of 3.5 mg/L propfol, 0. 1 μg/（kg·min） remifentanil, after loss of consciousness, 0. 9 mg/kg rocuronium was injected. Intubation was performed unless T1/Tc = 0 appeared in TO F - WATCH, according to which we should add rocuroniumin dose of 0. 3 mg/kg when two ballista appeared in machine. Onset time,effect duration and adding frequency of roeuronium and extubation time were recorded. In anesthesia recovery room （PACU） , residual neuromuscular block was measured. Re- suits There was no significant difference in onset time of rocuronium between two groups （ P 〉 0. 05 ）. The duration of rocuronium in group B was longer than in group A （ P 〈 0. 05 ）. And frequency of adding medicine is less in group B （ P 〈 0. 05 ）. And extubation time in group A was longer than which in group B （ P 〈 0. 05 ）. The incidence rate and duration of residual neuromuscular block in group A were more than in group B （P 〈 0. 05 ）. Conclusion The general anesthesia combined epidural block and epidural postoper- ative analgesia （PCEA） and muscle relaxant monitoring for fast track colon surgery could prolong the action time of rocuronium during operation ; reduce the incidence rate and duration of remains of musel relaxants ; and improve postoperative recovery quality.