全麻诱导期肺顺应性变化率与肌松药起效时间的相关性分析

Correlation analysis between the ration of changing lung compliance and the onset time of muscle relaxant during anesthesia induction

目的探讨全身麻醉诱导期正压通气至肌松起效时,肺顺应性及其变化率与肌松药起效时间的相关性。方法选择全麻下择期妇科腹腔镜手术患者35例,年龄18~50岁,体重45~80 kg,ASA Ⅰ或Ⅱ级,Mallampati 1—2级。麻醉诱导自主呼吸消失后行面罩压力控制通气,通气压力为15 cmH2O,每12秒记录肺顺应性,以第一次正压通气的肺顺应性为基础值。同时给予顺式阿曲库铵,肌松监测仪定标开始监测,间隔12 s直至T4/T1=0即肌松药起效,记录肌松起效时间和此时肺顺应性数值,计算肺顺应性变化率。结果给予肌松药即刻肺顺应性为(23.1±2.5)ml/cmH2O,当T4/T1=0时,肺顺应性为(44.6±8.7)ml/cmH2O。平均肌松起效时间为(87.1±7.3)s,肺顺应性变化率与肌松药起效时间呈负相关(r=-0.68,P=0.013)。结论全麻诱导时肺顺应性变化率与肌松药起效时间负相关,观察肺顺应性的变化有助于更准确地判断气管插管时机。

Objective To investigate the correlation between lung compliance or the ration of chan- ging lung compliance and the onset time of muscle relaxants during the induction of general anesthesia. Methods Thirty-five female patients undergoing gynecology laparoscopic surgery, aged 18 - 50 years, weighing 45 - 80 kg, falling into ASA physical Ⅰ or Ⅱ and Mallampati 1 - 2 were inrolled in this study. When anesthesia was induced and spontaneous breathing disappeared, they underwent mask pressure control ventilation with 15 cmH2O positive pressure. Lung compliance was recorded every 12 s, the lung compliance of the first positive pressure ventilation was the base line;meanwhile patients were given cis-atracurium and the value of train-of-four was monitored at 12 s interval until T4 / T1 = 0, muscle relaxant;the onset time, as well as the lung compliance index were recorded and the rate of change in lung compliance was calculated. Results The compliance of lung was ( 23. 1 ± 2. 5) ml / cmH2 O at the first ventilation,( 44. 6 ± 8. 7) ml / cmH2O after the onset of muscle relaxant. Negative correlation was found between lung compliance ratio and the onset time of muscle relaxants( r =-0. 68, P = 0. 013). Conclusion The ration of change in lung compliance is negatively correlated with the onset time of muscle relaxants. Observing the changing of lung compliance is useful to judge the endotracheal intubation time more accurately.