强直刺激后计数在妇科腹腔镜手术应用的可行性研究

The feasibility of using post-tetanic count in gynecologic laparoscopic surgery

目的探讨在妇科腹腔镜手术中,将强直刺激后计数(PTC)作为肌松药物增药指标的可行性。方法选择30例择期行妇科腹腔镜手术的患者,美国麻醉医师协会(ASA)麻醉风险分级Ⅰ~Ⅱ级,年龄>18岁。麻醉诱导时给予顺式阿曲库铵0.1 mg/kg(2ED95)。记录顺式阿曲库铵的起效时间t_0[注药毕至首个肌颤搐(T_1)抑制至0的时间],t_1(最后1次注药毕至PTC出现的时间),t_2(最后1次注药毕至T_1出现的时间),t_3(PTC开始出现至T1出现的时间),T_1恢复时PTC的值(PTC at T_1),以及PTC恢复之前出现呛咳的患者例数,T_1恢复之前出现呛咳的患者例数。结果 t_0为(3.67±0.79)min,t_1为(26.61±6.54)min,t_2为(39.44±5.94)min,t_3为(12.83±5.26)min,PTC at T_1为(11.8±2.6)次,PTC恢复之前无患者出现呛咳,T_1恢复之前3例出现呛咳。经Pearson相关性检验,PTC与T_1恢复时间呈显著负相关(r=-0.807,P<0.0001),回归方程可表示为t=13.085-0.629 PTC。结论妇科腹腔镜手术中,采用顺式阿曲库铵肌松阻滞,PTC与T_1恢复时间具有良好相关性,可通过PTC数值初步估计T_1出现的时间,PTC是深度神经肌肉阻滞程度的监测指标,作为妇科腹腔镜手术肌松药的增药指标具有一定的可行性。

Objective To explore the feasibility that post-tetanic count（PTC） as muscle relaxant injection index in gynecologic laparoscopic surgery. Methods Thirty patients （ASA I-II） scheduled for elective gynecologic laparoscopic surgery were enrolled into this study. 0. 1 mg/kg of cisatracurium was injected during the induction. The following parameters were recorded： the onset time （to）, the time between the injection of neuromuscular blocking drugs and the recovery of post-tetanie count （h） or the recovery of T1 （h）, the time between the recovery of PTC and T1 （t3）, PTC at T1, the number of chocking patients before the recovery of post-tetanic count（nptc） and before the recovery of T1 （nT1）. Results The average age of the 30 patients was （49±11） years old, BMI was （23.6±7.0）kg/m^2. The to was （3.67±0.79） min, t0 was （26.61±6.54）min, t2 was （39.44±5.94）min, t3 was （12.83±5.26）min, nPTC was 0, nT1 was 3. The result of Pearson correlation analysis indicated a remarkable minus correlation with PTC and T1 （ r =-0.807, P〈0.0001）. The regression equation could be expressed as t=-13.085-0.629PTC. Conclusion PTC method can be used to predict the time of first response to TOF nerve stimulation during intense neuromuscular blockade induced by cisatracurium in gynecologic laparoscopic surgery, since PTC correlates well with T1. As a monitoring indicator of deep neuromuscular blockade, PTC method can be used as muscle relaxant injection index.