肺保护性通气所致呼吸性酸血症对罗库溴铵神经肌肉阻滞持续时间的影响

Effect of respiratory acidosis induced by pulmonary protective ventilation on the duration of neuromuscular blockade of rocuronium

目的探讨肺保护性通气所致呼吸性酸血症是否增加罗库溴铵神经肌肉阻滞的持续时间。方法选择择期全麻手术的患者114例,男57例,女57例,年龄20～79岁, BMI 19～28 kg/m^2,ASAⅠ或Ⅱ级。随机分为两组:S组和L组,每组57例。麻醉诱导后,所有患者给予罗库溴铵0.6 mg/kg;S组患者根据预测体重V_T 10 ml/kg,不实施呼气末正压通气(PEEP);L组患者根据预测体重V_T 6 ml/kg,PEEP 5 cmH_2O。第一次抽搐后,立即给予罗库溴铵0.15 mg/kg。采用拇内收肌成串刺激加速度成像监测神经肌肉阻滞程度。记录静注罗库溴铵即刻到第一次抽搐的首次自发恢复时间(T1),从第一次抽搐后首次自发恢复到第二次恢复的时间(T2)。检测首次自发恢复和第二次自发恢复时动脉血pH值、PaCO_2、BE和体温。结果与S组比较,L组T1和T2均明显延长(P<0.05)。与S组比较,首次自发恢复和第二次自发恢复时L组pH明显降低,PaCO_2明显升高(P<0.01)。两组BE和体温差异无统计学意义。结论肺保护性通气所致呼吸性酸血症可延长罗库溴铵神经肌肉阻滞的持续时间。

Objective To investigate whether respiratory acidemia caused by pulmonary protective ventilation increases the duration of rocuronium neuromuscular blockade.Methods A total of 114 patients,57 males and 57 females,aged 20-79 years,BMI 19-28 kg/m^2,were selected.After anesthesia induction,rocuronium bromide was given 0.6 mg/kg.The tidal volume and positive end-expiratory pressure(PEEP)were randomly assigned 10 ml/kg to predict weight and 0cm H2O(group S)or 6 ml/kg and 5 cmH2O(group L)respectively.The respiratory rate was set to 10 beats per minute.The neuromuscular block was monitored by a series of stimuli which stimulated the adductor muscle acceleration imaging.Rocuronium bromide was immediately given at a dose of 0.15 mg/kg.The time from the first injection of rocuronium to the first convulsion was defined as T1.The first recovery time to the second recovery time was defined as T2.The pH,PaCO2,BE in arterial blood and body temperature at the first recovery time and the second recovery time were measured.Results Compared with group S,T1 and T2 in group L were significantly longer(P<0.05).Compared with group S,pH in group L was significantly lower at the first and second recovery time,PaCO2 was significantly higher(P<0.01).BE and body temperature in the two groups had no statistic differences.Conclusion Respiratory acidemia caused by pulmonary protective ventilation could prolong the duration of rocuronium neuromuscular blockade.