不同剂量米库氯铵在喉返神经监测甲状腺手术中的应用

Application of different doses of mivacurium chloride in recurrent laryngeal nerve monitoring thyroid surgery

目的观察不同剂量米库氯铵在喉返神经监测甲状腺手术中的应用效果。方法选择择期行甲状腺癌根治术患者90例,将患者随机分成3组,每组30例。所有患者均采用气管内插管全身麻醉,分别给予米库氯铵0.2 mg/kg(M1组),米库氯铵0.25 mg/kg(M2组),罗库溴铵0.6 mg/kg(R组)进行麻醉诱导。使用TOF-Watch SX肌松监测仪全程监测肌松,达到最大肌松抑制后插入美敦力标准加强型神经监测气管导管,术中全凭静脉维持麻醉深度。记录诱导时(T_0)、最大肌松抑制时(T_1)、TOF值为25%时(T_2)、TOF值为75%时(T_3)各时点患者的基本生命体征,记录首次喉返神经探测时间及喉返神经探测出的肌电振幅数值,同时观察各组不良反应发生情况。结果三组患者一般情况、各时点平均动脉压及心率比较,差异无统计学意义(P>0.05);三组患者气管插管成功率均为100%,M1组插管时间长于M2组、R组,M2组与R组比较差异无统计学意义(P>0.05);三组患者插管评分比较差异无统计学意义(P>0.05);三组患者从麻醉诱导至使用喉返神经监测仪所需时间比较,差异无统计学意义(P>0.05);R组肌电位振幅低于M1组、M2组,差异有统计学意义(P<0.05),M1组与M2组比较差异无统计学意义(P>0.05);三组患者均未出现术中体动,M1组出现3例皮肤潮红,M2组出现2例,R组未出现,三组不良反应发生率比较差异无统计学意义(P>0.05)。结论 0.25 mg/kg米库氯铵用于麻醉诱导不影响喉返神经监测,同时能满足气管插管及手术需要,适用于喉返神经监测甲状腺手术的麻醉。

Objective To observe the effect of different dosages of mivacurium chloride in recurrent laryngeal nerve(RLN)monitoring thyroid surgery.Methods Totally 90 patients with radical thyroidectomy were randomly divided into 3 groups,30 cases in each group.All patients were given anesthesia of endotracheal intubation,and were induced by micuronium 0.2 mg/kg(group M1),micuronium 0.25 mg/kg(group M2)and rocuronium 0.6 mg/kg(group R).TOF-Watch SX muscle relaxation monitor was used to monitor muscle relaxation during the whole process.After the maximum inhibition of muscle relaxation,Medtronic standard enhanced nerve monitoring tracheal tube was inserted.The anesthesia depth was maintained by vein during the operation.The basic vital signs of the patients at induction time(T0),maximum muscle relaxation inhibition time(T1),TOF value of 25%(T2)and TOF value of 75%(T3)were recorded;the first detection time of RLN and the value of EMG amplitude detected by RLN were recorded,and the adverse reactions of each group were observed.Results There was no significant difference in general condition,average arterial pressure or heart rate among the three groups(P>0.05).The success rate of tracheal intubation in the three groups was 100%.The intubation time of group M1 was longer than that of group M2 and group R.There was no significant difference between group M2 and group R(P>0.05).There was no significant difference in intubation score among the three groups(P>0.05).There was no significant difference in the time from anesthesia induction to the use of RLN monitor among the three groups(P>0.05).The amplitude of myoelectric potential in group R was lower than that in group M1 and group M2,the difference being statistically significant(P<0.05).There was no significant difference between group M1 and group M2(P>0.05).No intraoperative movement was observed in the three groups;there were 3,2 and 0 cases of skin flushing in group M1,group M2 and group R,and the difference in the incidence of adverse reactions was not statistically significant(P>0.05).Conclusion Micuronium chloride at 0.25 mg/kg used in anesthesia induction does not affect the monitoring of RLN,which can meet the needs of tracheal intubation and operation,so it is suitable for the anesthesia in RLN monitoring thyroid surgery.