罗库溴铵和顺阿曲库铵肌松残余作用发生率分析

Analysis of incidence of residue neuromuscular blockade for rocuronium and cisatracurium

目的:观察全身麻醉使用罗库溴铵或顺阿曲库铵后,以临床征象判断肌松程度,术毕和拔除气管导管时肌松药残余作用发生率,及引起肌松药残余作用的危险因素。方法:成年择期手术患者500例,分别实施丙泊酚-瑞芬太尼静脉麻醉或七氟醚吸入麻醉,麻醉手术期间分别给予罗库溴铵或顺阿曲库铵。用TOF Watch SX监测仪盲法观察麻醉过程透皮连续4次(TOF)监测时第4次刺激肌颤搐反应值与第1次刺激肌颤搐反应值的比值(TOFr)的变化。结果:术毕平均TOFr=0.53±0.38,其中275例0<TOFr<0.9,112例TOFr=0。拔管时平均TOFr=0.97±0.12,其中60例TOFr<0.9。随着年龄或体质指数增加,拔管时肌松药残余作用发生率呈增加趋势。术毕给予新斯的明至拔管间隔时间≥10 min者拔管时平均TOFr值比<10 min者明显高。结论:凭临床征象和经验估计罗库溴铵和顺阿曲库铵作用消除程度,拔除气管导管时12%的患者TOFr<0.9,存在肌松药残余作用的隐患。年龄增大及给予肌松药后或给予新斯的明拮抗后至拔管时间偏短是增加肌松药残余作用发生率的主要危险因素。

Objective:To observe the incidence of residual neuromuscular blockade at the end of operation and during tracheal extubation,and to analyze the risk factors causing residual neuromuscular blockade by judging the degree of muscle relaxation according to clinical signs when after using rocuronium or cisatracurium in general anesthesia.Methods:A total of 500 adult patients were implemented with propofol-remifentanil intravenous anesthesia or sevoflurane inhalation anesthesia.Rocuronium and cisatracurium were given,respectively.The ratio of the response value of the fourth stimulation to that of the first stimulation during the four consecutive times of skin penetration(TOF)monitoring(TOFr)was observed with blind method by TOF Watch SX monitor during anesthesia.Results:The mean TOFr was 0.53±0.38 at the end of operation,including 275 cases of 0<TOFr<0.9 and 112 cases of TOFr=0.The mean TOFr was 0.97±0.12 at extubation,including 60 cases of TOFr<0.9.The incidence of residual neuromuscular blockade at extubation showed an increasing trend with the increase of age or body mass index.The average TOFr value at extubation of patients with interval time over 10 min between neostigmine administration and extubation was significantly higher than those who had the interval time less than 10 min.Conclusions:There have been 12%patients with TOFr<0.9 when extubation by estimating rocuronium and cisatracurium effect with clinical signs and experience;there are hidden dangers of residual neuromuscular blockade.The main risk factors for increasing the incidence of the residual neuromuscular blockade are growing old and the short time of administrating muscle relaxants or neostigmine to extubation.