甲状腺术中神经监测手术麻醉诱导肌松药物的随机对照试验

A Randomized Controlled Trial of Muscle Relaxants in Recurrent Laryngeal Nerve Monitoring during Thyroid Surgery

目的:比较甲状腺手术中神经电生理监测临床指南推荐1倍ED95顺阿曲库铵与临床麻醉推荐5倍ED95琥珀胆碱用于甲状腺喉返神经监测手术,对麻醉医生麻醉诱导插管操作和外科医生术中神经监测的影响。方法:择期甲状腺手术术中喉返神经监测患者103例,随机分为两组。C组51例,麻醉诱导时给予顺阿曲库铵0.05 mg/kg;S组52例,给予琥珀胆碱1.5 mg/kg。记录并比较两组患者气管插管条件评分、插管时间、等待时间、术中患者体动次数、术中血压下降、术后咽痛、声音嘶哑、肌痛发生率。结果:C组患者Cooper评分低于S组(t=30.730,P<0.001),C组插管时间比S组长(t=-24.988,P<0.001),S组肌松监测时间小于C组(t=-6.728,P<0.001);C组首次监测信号出现例数少于S组(χ^2=16.520,P<0.001),C组咽痛发生例数多于S组(χ^2=4.513,P=0.030)。两组患者术中无体动,血压下降、手术监测时间、肌痛方面的差异无统计学意义。结论:对于接受甲状腺喉返神经监测的手术患者,麻醉医生使用临床麻醉推荐剂量的琥珀胆碱麻醉诱导,不仅可以确保麻醉诱导插管安全,也不影响外科医生进行喉返神经功能监测。

Objective:To compare the effect of cisatracurium(1×ED95)and succinylcholine(5×ED95)on intubation and recurrent laryngeal nerve monitoring during thyroid surgery.Methods:103 patients were randomly divided into two groups,Group C and Group S.51 patients in Group C were given cisatracurium 0.05mg/kg;52 patients in Group S were given succinylcholine 1.5mg/kg.The Cooper score,intubation time,time for the presense of neuromonitoring signal,times of intraoperative body movements,incidence of intraoperative blood pressure drop,and postoperative pharyngeal pain,hoarseness and myalgia in two groups were recorded.Results:The Cooper score in Group C was lower than that in group S(t=30.730,P<0.001).The time of intubation in Group C was longer than that in Group S(t=-24.988,P<0.001).The time of neuromuscular monitoring was lower than that in Group C(t=-6.728,P<0.001).Accessible neuromonitoring signal was initially observed in fewer cases in Group C than in Group S(χ^2=16.520,P<0.001).The incidence of pharyngeal pain in Group C was higher than that in Group S(χ^2=4.513,P=0.030).There were no significant differences in intraoperative blood pressure drop,time of intraoperative nerve monitoring and postoperative myalgia between the two groups.No intraoperative body movements was observed.Conclusion:Clinically recommended doses of succinylcholine-induced anaesthesia can not only ensure the safety of intubation,but also guarantee the effectiveness of recurrent laryngeal nerve monitoring during thyroid surgery.