罗库溴铵用于良恶性头颈部肿瘤患者的肌肉松驰效应研究

Muscle Relaxant Effect of Rocuronium Bromide in Patients with Benign and Malignant Head and Neck Tumor

目的观察罗库溴铵对不同类型肿瘤患者的肌肉松驰（简称肌松）时间的影响。方法选取拟在全身麻醉（简称全麻）下行头颈部肿瘤切除术患者68例,按肿瘤的严重程度分为A组（恶性）及B组（良性）,各34例。两组患者均静脉注射丙泊酚、芬太尼、罗库溴铵行麻醉诱导;以成串刺激监测神经肌肉阻滞深度,在4个成串刺激中的第1个颤搐反应（T1）达最低时行气管插管;T1恢复至10%开始输注罗库溴铵并维持在5%~10%,术毕停用罗库溴铵,用新斯的明拮抗肌松效应。记录罗库溴铵的肌松作用指标。结果与A组相比,B组起效时间明显缩短,最大效应持续时间延长、T1恢复至10%的时间、T1自10%恢复至50%的时间、恢复指数均明显缩短（P〈0.05）;B组气管插管条件明显优于A组（P〈0.05）;两组患者不良反应发生率比较,差异无统计学意义（P〉0.05）。结论头颈部良性肿瘤患者的罗库溴铵肌松效应较恶性肿瘤患者敏感,头颈部良性肿瘤患者罗库溴铵起效时间和恢复时间均较恶性肿瘤患者缩短。

Objective To observe the efficacy of rocuronium in muscle relaxants time between different types of tumor patients. Methods 68 patients under general anesthesia in head and neck tumor resection were divided into two groups,Malignant（group A） and Benign （group B）,34 case in each group. The two groups received intravenous injection of propofol,fentanyl,rocuronium for anesthesia induc- tion. In clusters stimulate was used to monitor neuromuscular blockade depth, and when the first twitch in the fourth clusters stimulate response （T~） reached the lowest point the endotracheal intubation was conducted. When the T~ recovered to 10% started infusion of rocuronium and maintained at 5% to 10%. After surgery,stopped the use of rocuronium,and used neostigmine for the antagonistic mus- cle relaxant effect. The muscle relaxation index of rocuronium was recorded. Results Compared with group A,the onset time of group B was significantly shorter,the duration of the maximum effect was more extended,the time of T~ recovery to 10% ,from 10% to 50% , and the recovery index were significantly shortened（ P 〈 0. 05 ）;the intubating conditions of group B was better than group A （P 〈 0. 05）;there was no statistically significant difference between the two groups in the occurrence rate of adverse reactions（P 〉 0. 05）. Conclusion Rocuronium has more sensitive muscle relaxant effect on patients with head and neck benign tumor,the onset time and recovery time in patients with head and neck benign tumor are significantly shortened compared with patients with malignant tumor.