腹腔镜腹部手术苯磺顺阿曲库铵持续输注的麻醉效果和安全性

Effects and safety of continuous infusion of cisatracurium in laparoscopic abdominal surgery

目的:探究苯磺顺阿曲库铵(以下简称顺阿曲库铵)持续输注在腹腔镜腹部手术麻醉中的有效性和安全性。方法:选取2019年1月至2020年1月于瑞金医院古北分院择期行腹腔镜腹部手术病人90例,随机分为持续输注组、间断输注组,每组45例。对两组顺阿曲库铵用药量、起效时间、肌肉松弛不足发生次数、拔除气管导管时间、恢复指数[四个成串刺激(train of four stimulation,TOF)T1从25%恢复至75%的时间]、TOF 70%(停药到TOF恢复为70%的时间)、TOF 90%(停药到TOF恢复为90%的时间),以及麻醉期、诱导期平均动脉压、心率和不良反应发生情况进行比较。结果:两组顺阿曲库铵起效时间差异无统计学意义(P=0.102)。持续输注组肌肉松弛不足发生次数和顺阿曲库铵用药量显著低于间断输注组(P=0.003,P<0.001)。两组拔管时间差异无统计学意义(P=0.095)。持续输注组病人恢复指数、TOF 70%、TOF 90%均显著低于间断输注组(P均<0.001)。两组麻醉期和诱导期平均动脉压及心率以及不良反应发生率差异均无统计学意义(P>0.05)。结论:腹腔镜腹部手术病人持续输注顺阿曲库铵较间断输注获得更好的肌肉松弛效果,减少用药量,缩短恢复指数,不良反应减少。

Objective To explore the effects and safety of continuous infusion of cisatracurium in laparoscopic abdominal surgery.Methods Ninety patients undergoing elective laparoscopic abdominal surgery in Gubei Branch of Ruijin Hospital from January 2019 to January 2020 were randomly divided into continuous infusion group(n=45)and intermittent infusion group(n=45).Parameters including dosage of cisatracurium,onset time,lack of muscle relaxant occurrences,extu-bation time,recovery index,which was stimulation with train of four(TOF)and T1 recovery from 25% to 75%,TOF 70%(recovery time for 70% from drug withdrawal to TOF),TOF 90%(recovery time for 90% from drug withdrawal to TOF),both mean arterial pressure and heart rate during anesthesia and during induction,and adverse reactions were compared be-tween two groups.Results There was no significant difference in onset time of cisatracurium between two groups(P=0.102).Lack of muscle relaxant occurrences(P=0.003)and dosage of cisatracurium(P<0.001)in continuous infusion group was significantly lower than those in intermittent infusion group.There was no significant difference in extubation time between two groups(P=0.095).Recovery index,TOF 70% and TOF 90% in continuous infusion group were significantly lower than those in intermittent infusion group(P<0.001).There was no significant difference in both mean arterial pressure and heart rate during anesthesia and during induction(P>0.05)and in the incidence of adverse reactions(P>0.05)between two groups.Conclusions Compared with intermittent infusion,continuous infusion of cisatracurium in laparoscopic abdominal surgery could have more effect of muscle relaxation,reduce the dosage of cisatracurium,shorten recovery index and reduce ad-verse reactions.