比较不同剂量罗库溴铵用于关腹的临床疗效

Comparison of Different Dosages of Rocuronium on Abdominal Wound Closure

目的评价全麻下行腹部手术关腹时追加不同剂量罗库溴铵对手术肌松的影响.方法择期全凭静脉麻醉下行开腹手术患者90例,ASA分级Ⅰ~Ⅱ级,随机分为A、B、C 3组,分别于关腹时追加1ED95(0.3mg/kg)、0.5ED95(0.15 mg/kg)、0.2 ED95(0.06 mg/kg)的罗库溴铵量,记录给药后TOF值恢复至25%、75%、90%时间、患者睁眼的时间、抬头>5 s的时间、拔出气管导管的时间、拔管后上呼吸道梗阻及手术医生对关腹时肌松满意度评分等指标.结果 3组患者关腹前的TOF值比较差异无统计学意义(P>0.05),与A、B组比较,C组给药后TOF值明显延长(P<0.05),给药后TOF恢复25%、75%、90%的时间点,C组比A、B组明显缩短(P<0.01);与A、B组比较,C组给药后至患者睁眼的时间、抬头>5 s的时间、气管拔管的时间差异有统计学意义(P<0.05);拔管后A、B、C 3组分别有8、4、0例患者在2 h内发生上呼吸道梗阻,差异有统计学意义(P<0.05);肌松满意评分3组差异无统计学意义(P>0.05).结论关腹时给予0.2倍的ED95罗库溴铵可以产生有效的临床肌松作用,无明显不良反应.

Objective To evaluate the effects of different dosages of rocuronium on abdominal wound closure under general anesthesia.Me thods Ninety ASA class I or II patients scheduled for elective abdominal surgery under general anesthesia were randomized into three groups with 30 cases each.Each group received rocuronium 1 time of ED95（0.3 mg/kg）,0.5 time of ED95（0.15 mg/kg）,0.2 time of ED95（0.06 mg/kg） respectively when closing the abdominal wall.TOF recovered to 25%, 75%, 90%, time of eye-opening on command, time of head-lift for more than 5 seconds,extubation time, the rate of upper airways obstruction after extubation and the satisfaction score for the muscle relaxation to general surgeons were recorded.Re s ults TOF values had no significantly different among the three groups before abdominal wound closure（P〉0.05）.Compared with group A and group B,time of TOF in group C was significangtly increased after administration of rocuronium（P〈0.05）.Time of TOF recovery to 25%, 75%, 90% in group C were significangtly decreased（P〈0.01）.Compared with group A and group B, time of eye-opening on command,head-lift for more than 5 seconds and extubation time were significantly shorter in group C.There were 8, 4, 0 patients undwent upper airways obstruction among each group respectively after extubation（P〈0.05）.The satisfaction score for muscle relaxation among three groups had no significant difference.Conclus ion An additional administration of 0.2 time of ED95（0.06 mg/kg）rocuronium before abdominal wound closure in abdominal surgery can achieve satisfactory muscle relaxation for surgeons.