罗库溴铵单次给药在开颅听神经瘤切除术中的临床应用

Administration of the Single-dose Rocuronium in Patients Undergoing Craniotomy for Acoustic Neuroma Resection

目的探讨全凭静脉麻醉下开颅听神经瘤切除术中肌松药罗库溴铵最佳单次给药剂量,在满足全身麻醉诱导气管插管的同时,尽快实现无肌松干扰的面神经功能的精准监测。方法本研究为随机对照开盲的临床试验。将28例择期行开颅听神经瘤切除术的患者随机分为两组(每组14例),静脉单次给予罗库溴铵0.3 mg·kg^(-1)(R_(0.3))组和罗库溴铵0.6 mg·kg^(-1)(R_(0.6))组。采用4个成串刺激(TOF)监测两组患者肌松药起效(TOF计数)和消除(TOF比值)情况,并记录气管插管时血压、心率、声门暴露(Cormack-Lehane喉镜显露分级)、气管插管(Cooper评分)情况和插管尝试次数。结果①气管插管时,R_(0.6)组肌松效果优于R_(0.3组,R_(0.3组7例(50%)和R_(0.6)组14例(100%)患者达到中深度肌松(TOF计数为0～2,P=0. 004)。②两组患者Cormack-Lehane分级和Cooper评分均差异无显著性,所有患者气管插管均一次成功。R_(0.3)组和R_(0.6)组的罗库溴铵剂量均能满足气管插管的肌松要求。③R_(0.3)组与R_(0.6)组比较,肌松药消除加快,TOF比值恢复至90%(TTOF 90%)所需时间显著减少(P<0.0001)。结论在丙泊酚-瑞芬太尼全凭静脉麻醉下,单次静脉给药罗库溴铵0.3 mg·kg-1 (理想体重)能满足气管插管的肌松要求,可加快获取面神经监测的术前基线值,有助于听神经瘤切除术中面神经功能的精准监测。

Aim To investigate the optimal single dose of muscle relaxant rocuronium for tracheal intubation and facial nerve function monitoring in patients undergoing craniotomy for resection of acoustic neuroma with total intravenous anesthesia. Methods The current study was a random controlled openblinded clinical trial. Twenty-eight patients undergoing elective acoustic neuroma resection were randomly divided into two groups: R0.3 group(0. 3 mg·kg^-1 rocuronium, 14 cases) and R0.6 group(0.6 mg ·kg^-1rocuronium,14 cases).Train-of-four stimulation(TOF) were used to monitor muscle relaxation(TOF counting) and recovery(TOF ratio). Blood pressure,heart rate,glottic exposure(Cormack-Lehane laryngoscopy scores),tracheal intubation response( Cooper scores),and the number of intubation attempts were compared between the two groups. Results ①Muscle relaxation is better in R0.6 group than R0.3 group at the time of tracheal intubation. 7 patients(50%) in R0.3 group and 14 patients(100%) in R0.6 group achieved medium-deep muscle relaxation(TOF counting 0-2, P =0.004).②There were no significant differences in Cormack-Lehane scores and Cooper scores between the two groups. All patients were intubated successfully in the first attempt. 0. 3 mg · kg ^-1 rocuronium provided the same muscle relaxation effects as 0. 6 mg ·kg^-1 rocuronium for endotracheal intubation.③ Compared to R0.6 group,the recovery time of muscle relaxation was shorter in R0.3 group. The administration of 0. 3 mg ·kg^-1 rocuronium significantly reduced the duration of TOF ratio reaching to 90%(T TOF90%,P < 0. 000 1). Conclusion With propofol-remifentanil anesthesia, a single-dose rocuronium of 0. 3 mg ·kg^-1(ideal body weight) can provide satisfied muscle relaxation for endotracheal intubation, and accelerate acquisitions for preoperative baseline values of facial nerve monitoring,which facilitate accurate monitoring of facial nerve function during acoustic neuroma resection.