顺阿曲库铵不同持续泵注速度对上腹部开腹手术肌肉松弛和肌肉松弛恢复的影响

Effects of different continuous infusion rates of cisatracurium on muscle relaxation and recovery of muscle relaxation during upper abdominal laparotomy

目的·探究顺阿曲库铵不同持续泵注速度对上腹部开腹手术肌肉松弛和肌肉松弛恢复的影响。方法·选取2019年1月—2020年1月于民航上海医院/瑞金医院古北分院择期行上腹部开腹手术患者60例,按照随机数字表根据术中泵注顺阿曲库铵速度将其分为低剂量[1.0μg/(kg·min)]组(L组)、中剂量[1.5μg/(kg·min)]组(M组)和高剂量[2.0μg/(kg·min)]组(H组),每组各20例。记录并比较3组患者在麻醉诱导期间顺阿曲库铵用量,术中累计泵注剂量,术中肌肉松弛满意度,停药到4个成串刺激(train of four stimulation,TOF)比率恢复至0.25、0.75、0.80、0.90的时间(TOFr 0.25、TOFr 0.75、TOFr 0.80、TOFr 0.90)以及拔管时间。结果·3组患者在麻醉诱导期间顺阿曲库铵用量方面差异无统计学意义(P=0.662);L组术中累计泵注剂量低于M组和H组(P=0.025);3组患者在术中肌肉松弛满意度方面差异无统计学意义(P=1.000)。L组患者TOFr 0.25、TOFr 0.75、TOFr 0.80、TOFr 0.90以及拔管时间显著短于M组和H组(P=0.000);而M组和H组相比上述指标的差异无统计学意义(P>0.05)。结论·在上腹部开腹手术中以1.0μg/(kg·min)的速度持续泵注顺阿曲库铵即可提供良好的肌肉松弛状态。泵注剂量增大并不能明显提升肌肉松弛效果,反而会延长肌肉松弛恢复时间以及拔管时间。

Objective·To investigate the effects of different continuous infusion rates of cisatracurium on muscle relaxation and recovery of muscle relaxation in upper abdominal laparotomy.Methods·From January 2019 to January 2020,60 patients scheduled for upper abdominal laparotomy in Shanghai Civil Aviation Hospital/Gubei Branch of Ruijin Hospital were randomly divided into low dosage[1.0μg/(kg·min)]group(L group),middle dosage[1.5μg/(kg·min)]group(M group)and high dosage[2.0μg/(kg·min)]group(H group),according to the speed of intraoperative pump injection of cisatracurium,with 20 cases in each group.The amount of cisatracurium during the induction period,the cumulative pumping dosage during the operation,intraoperative muscle relaxation satisfaction,the time from drug withdrawal to the train of four stimulation(TOF)ratio recovery to 0.25,0.75,0.80 and 0.90(TOFr 0.25,TOFr 0.75,TOFr 0.80,TOFr 0.90)and extubation time were recorded and compared among the three groups.Results·There was no significant difference in the dosage of cisatracurium during induction among the three groups(P=0.662).The cumulative pump the dosage in the L group was lower than those in the M and H groups(P=0.025).There was no significant difference in intraoperative muscle relaxation satisfaction among the three groups(P=1.000).TOFr 0.25,TOFr 0.75,TOFr 0.80,TOFr 0.90 and extubation time in the L group were significantly shorter than those in the M and H groups(P=0.000),but there was no significant difference between M group and H group(P>0.05).Conclusion·Continuous infusion of cisatracurium at the rate of 1.0μg/(kg·min)during upper abdominal laparotomy can provide a good state of muscle relaxation.The increase of pump dosage can not significantly improve the effect of muscle relaxation,but can prolong the recovery time of muscle relaxation and extubation time.