米库氯铵持续输注在老年患者腹腔镜手术中的应用

The application of continuous Mivacurium infusion in elderly patients undergoing laparoscopic surgery

目的探讨米库氯铵持续输注在老年患者长时间腹腔镜手术中应用的安全性及有效性。方法择期全麻行腹腔镜结直肠癌根治术患者50例,ASAⅠ~Ⅲ级,年龄≥65岁,随机分为顺式阿曲库铵组（A组）和米库氯铵组（B组）,每组25例。手术时间〉2h。连接Veryark-TOF肌松监测仪监测拇收肌诱发肌颤搐反应。麻醉诱导采用静脉注射咪达唑仑0.05mg/kg、芬太尼4μg/kg、依托咪酯0.3mg/kg、罗库溴铵0.6mg/kg。麻醉维持采用静脉泵注丙泊酚、瑞芬太尼、复合异氟醚吸入。气管插管后两组持续泵注顺式阿曲库铵或米库氯铵维持肌松,并根据肌松监测仪PTC模式调整泵入药量。记录麻醉诱导前（T1）、手术开始后2h（T2）、术毕（T3）、气管拔管时（T4）、拔管后30 min（T5）各时间点的平均动脉压（MAP）、心率（HR）、脉搏氧饱和度（SpO2）、呼气末二氧化碳分压（PETCO2）及PH值;记录TOFr恢复至90%的时间（t1）、恢复指数（t2）、拔管时间（t3）、PACU停留时间（t4）;记录拔管时TOFr〈0.9的患者数并计算肌松残余率;观察出现不良反应的病例数。结果在T4、T5时点,B组的PETCO2明显低于A组,差异有统计学意义（P〈0.05）;B组患者TOFr恢复到90%的时间（t1）、恢复指数（t2）、拔管时间（t3）和PACU停留时间（t4）明显短于A组,差异有统计学意义（P〈0.05）;拔管时B组TOFr〈0.9的病例数及肌松残余率均明显小于A组,差异有统计学意义（P〈0.05）。结论米库氯铵持续输注能安全用于老年患者长时程腹腔镜结直肠癌根治术,术中肌松效果满意,术后神经肌肉功能恢复快、肌松残余发生率低、无明显不良反应,值得临床推广使用。

Objective To investigate the safety and effectiveness of continuous Mivacurium venous infusion in the application of periextubation period in elderly patients undergoing a long time laparoscopic surgery.Methods Fifty patients scheduled for laparoscopic colorectal cancer radical prostatectomy were randomized into two groups（n =25 each）：continuous Cisatracurium infusion（group A） and continuous Mivacurium infusion（group B）with the conditions of ASA Ⅰ~Ⅲ,age≥65 and operation time≥2 h.The contract reaction of adductor pollicis was monitored through Veryark-TOF by stimulating ulnar nerve.All the patients were intravenously given midazolam（0.05 mg/kg）,fentanyl（4 μg/kg）,etomidate（0.3 mg/kg）,and rocuronium（0.6 mg/kg） for anesthesia induction.Anesthesia was maintained with propofol,refentanyl,and isoflurance.Mivaeurium and cisatracurium were injected through venous pump after endotracheal intubation,according to PTC model of the Veryark-TOF to adjust the doses.MAP,HR,SpO2,PETCO2 and pH were recorded at the time before anesthesia induction（T1）,2h after surgery（T2）,end of the surgery（T3）,tracheal extubation（T4）,and 30 min after extubation（T5）.Recording the time of TOFr back to 90%（t1）,the recovery index time（t2）,the extubation time（t3）,and staying in the PACU time（t4）.Recording the number of patients with TOFr〈0.9 when the tube was drawn.Calculating the rate of muscle relaxant,and observing the number of cases of adverse reactions.Results The PETCO2 of B group was obviously lower than that of group A at T_4 and T_5,the difference was significant（P〈 0.05）.The time of t1~t4 in group B was obviously shorter than that of the group A（P〈 0.05）.The number of the patients,with TOFr〈 0.9 when the tube was drawn and the muscle relaxant residual rate in group B were significantly less than group A（P〈 0.05）.Conclusion For a long time colorectal cancer radical prostatectomy in elderly patients,Mivacurium continuous venous infusion is safe in laparoscopic surgery,the effect of muscle relaxant is satisfied,the function of neuromuscular recovery is faster,the incidence of muscle relaxant residual is lower,without obvious adverse reactions,and worthy widely use in the clinic.