罗库溴铵对急诊饱胃全身麻醉患者食管反流的影响

Effects of rocuronium on esophageal reflux in emergency patients with full stomach undergoing general anaesthesia

目的观察罗库溴铵对急诊饱胃全身麻醉患者食管反流的影响。方法急诊饱胃全身麻醉患者90例分3组(每组30例):正压通气组(Ⅰ组)、非正压通气1组(Ⅱ组)和非正压通气2组(Ⅲ组)。诱导时,Ⅰ组正压辅助通气,给予罗库溴铵0.6 mg/kg;Ⅱ、Ⅲ组面罩自主呼吸,Ⅱ组给予罗库溴铵0.6 mg/kg(分2次给予:0.06 mg/kg,0.54 mg/kg),Ⅲ组给予罗库溴铵0.9 mg/kg。记录插管10 min后食管反流气体、液体容积(m L)和食管反流液体酸碱度(pH)。结果与Ⅰ组患者[(气体(93±29)m L,液体(59±10)m L]比较,Ⅱ组患者[气体(73±23)m L,液体(45±8)m L]和Ⅲ组患者[气体(70±19)m L,液体(40±7)m L]食管反流气体和液体容积减少,液体酸碱度(pH)显著增加(P<0.05)。与Ⅱ组比较,Ⅲ组患者食管返流液体明显减少,液体酸碱度(pH)增加(P<0.05)。结论高剂量罗库溴铵(0.9 mg/kg)以及罗库溴铵预处理明显缩短诱导时间,能有效减少胃食管反流。

Objective To observe the effects of rocuronium on esophageal reflux in emergency patients with full stomach undergoing general anaesthesia. Methods Ninty patients with full stomach undergoing emergency general anaesthesia were randomly divided into three groups： positive pressure ventilation group （Group Ⅰ）, non-positive pressure ventilation group 1 （Group Ⅱ） and non-positive pressure ventilation group 2 （Group Ⅲ）, with 30 cases in each groups. Patients in Group Ⅰ received 0.6 mg/kg rocuronium for neuromuscular blockade during induction. Patients in Group Ⅱ were given 0.06 mg/kg rocuronium and followed by a dose of 0.54 mg/kg rocuronium. Patients in Group Ⅲ received 0.9 mg/kg rocuronium. Patients in Group Ⅰ were given assisted positive ventilation with mask. Patients in Group Ⅱ and Ⅲ keep spontaneous breathing with mask, without assisted positive ventilation. The volume, gaseous and potential hydrogen of esophageal reflux 10 min after intubation were recorded. Results Compared with Group Ⅰ, the volume of liquid and gaseous esophageal reflux of the patients in Group Ⅱ and Group Ⅲ were decreased significantly （ P 〈0.05）, while the value of potential of hydrogen of the liquid were increased significantly （ P 〈0.05）. Compared with Group Ⅱ, the volume of liquid esophageal reflux of the patients in Group Ⅲ were decreased significantly, while the value of potential of hydrogen were increased （ P 〈0.05）.Conclusion Rocuronium of 0.9 mg/kg and pretreatment with rocuronium significantly reduced the volume of the esophageal reflux effectively.