肌松程度对老年子宫肌瘤患者手术条件的影响

Effect of Muscle Relaxation on Surgical Conditions of Uterine Leiomyoma in Elderly Women

[目的]探讨肌松程度对老年子宫肌瘤患者手术条件的影响.[方法]选取2010年1月至2017年11月在本院拟行腹腔镜子宫肌瘤剔除手术的老年患者86例,按照随机数表法分为对照组和观察组,每组43例.观察组患者目标肌松程度为TOF1-2（适度肌松,四个成串刺激可保持1-2个肌颤搐）,对照组患者目标肌松程度为PTC1-2（深度肌松,强直刺激后单刺激肌颤搐为1-2个）,肌松监测下两组患者均采用持续输注顺式阿曲库铵维持肌松程度.比较两组患者的手术操作条件、手术医生评分、气管插管条件、肌松恢复情况和不良反应发生率.[结果]两组患者的手术耗时和手术医生评分比较差异无统计学意义（P〉0.05）;观察组患者平均气腹压高于对照组患者,观察组患者的拔管时间、4个成串刺激的比值（TOFr）恢复至0.7和TO-Fr恢复至0.9的时间均短于对照组,其差异均有统计学意义（P〈0.05）.两组患者的气管插管优良率均为100.00％,观察组和对照组患者不良反应总发生率分别为6.96％和4.64％,两组比较差异无统计学意义（P〉0.05）.[结论]老年子宫肌瘤患者给予TOF1-2肌松可获得较好的手术操作和气管插管条件,且肌松恢复时间短,无明显不良反应,值得临床推广应用.

[Objective]To investigate the effect of muscle relaxation on the surgical conditions of elderly women with uterine fibroids （leiomyoma）. [Methods]A total of 86 patients who underwent laparoscopic myo- mectomy in our hospital from January 2010 to November 2017 were selected and divided into the control group and the observation group according to random number table, with 43 cases each. Both groups of patients un- derwent continuous infusion of cis-atracurium to maintain muscle relaxation. In the observation group, the tar- get muscle relaxation degree was TOF1-2 （moderate muscle relaxation, i.e. four series of stimulation can maintain 1-2 muscle twitch）. In the control group, the target degree of muscle relaxation was PTC1-2 （deep muscle relaxation, i.e. 1-2 monostimulatory twitch after tetanic stimulation）. Operating conditions, endotra- cheal intubation conditions, recovery of muscle relaxants, surgeon score, and incidence of adverse reactions were compared between the two groups. [Results]There was no significant difference in operative time and surgeon score between the observation group and the control group （ P 〉0.05）. The mean pneumoperitoneal pressure and the extubation time in the observation group were higher than those in the control group. The ratios of 4 string stimulations （TOFr） recovery to 0.7 and 0.9 in the observation group were shorter than those in the control group （ P 〈0.05） . The excellent and good rate of tracheal intubation was 100.00% in both groups. The total incidence of adverse reactions in the two groups was 6.96% and 4.64%, respectively, with no significant difference （ P 〉0.05）. [Conclusion]The treatment of TOF1-2 muscle relaxant in elderly women with uterine fibroids can obtain better operating conditions and tracheal intubation conditions. The recovery time of muscle relaxant is short. There were no obvious adverse reactions, which can be further popularized and used in clinical practice.