术中保温对胃肠道手术患者顺式阿曲库铵肌肉松弛恢复的影响

Effect of intraoperative warming on muscle relaxation recovery of cisatracurium in patients undergoing gastrointestinal surgery

目的观察术中保温对胃肠道手术患者顺式阿曲库铵肌肉松弛恢复的影响。方法选择中国医学科学院肿瘤医院2016年10月至2019年3月全麻下行开腹胃肠道手术患者60例,年龄20~60岁,美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级。随机数字表法分为两组:N组为常规术中不保温组,H组为术中保温组,每组30例。采用全身麻醉顺式阿曲库铵0.15 mg/kg诱导气管插管,术中持续监测并记录患者鼻咽温度。术中静脉输注顺式阿曲库铵1~3μg·kg^-1·min^-1,维持4个成串刺激(TOF)引起的第一个肌颤触(T1)在1%~10%,手术结束前30 min停止输注。记录T1从25%恢复到75%的时间(肌肉松弛恢复指数),T1恢复至25%到TOF比值(TOFR,即TOF中第4个肌颤搐高度与T1的比值)恢复至90%的时间(完全恢复时间),药物累计用量,手术时间。结果两组患者药物累计用量和手术时间差异均无统计学意义(均P>0.05);N组术毕体温为(35.7±0.2)℃,显著低于H组的(36.2±0.1)℃,差异有统计学意义(t=13.940,P<0.01);N组肌肉松弛恢复指数为(16.5±1.8)min,显著高于H组的(10.5±2.1)min,差异有统计学意义(t=12.094,P<0.01),N组完全恢复时间为(26.9±4.1)min,较H组的(15.0±2.9)min显著延长,差异有统计学意义(t=13.082,P<0.01)。结论开腹胃肠道手术患者术中容易发生低体温,术中保温有助于顺式阿曲库铵的肌肉松弛作用的恢复。

Objective To investigate the effect of intraoperative warming on the postoperative relaxation recovery of cisatracurium in patients undergoing gastrointestinal surgery.Methods Sixty ASAⅠ-Ⅱpatients,aged 20 to 60,undergoing elective gastrointestinal surgery in Cancer Hospital Chinese Academy of Medical Sciences from October,2016 to March,2019 were selected and they were randomly divided into two groups(n=30),N group and H group by random number table.N group was non-heat preserving group,and H group was heat preserving group.Tracheal intubation was induced by general anesthesia with cisatracurium 0.15 mg/kg,and the nasopharyngeal temperature were continuously monitored and recorded.Cisatracurium were infused 1-3μg·kg-1·min-1 by venous pump during operation with T1 at 1%-10%and stopped infusion 30 minutes before the end of surgery.The time when T1 recovered from 25%to 75%(muscle relaxation recovery index),and the time of T1 recovered to 25%to TOF ratios(TOFR,the ratio of the fourth muscle twitch height to T1 in TOF)recovery to 90%(full recovery time),cumulative drug use and surgery time were recorded.Results There was no significant difference between the two groups in the cumulative drug dosage and operation time(P>0.05).The body temperature N group(35.7±0.2)℃was significantly lower than the H group(36.2±0.1)℃(t=13.940,P<0.01).The recovery index of N group(16.5±1.8)min was significantlyhigher than H group(10.5±2.1)min(t=12.094,P<0.01)and complete recovery time in N group(26.9±4.1)min was obviously longer than those in H group(15.0±2.9)(t=13.082,P<0.01).Conclusions Patients with open gastrointestinal surgery are prone to hypothermia during surgery and heat protection is helpful to muscle relaxation recovery of cisatracurium.