无症状人类免疫缺陷病毒感染患者全凭静脉麻醉中顺阿曲库铵的骨骼肌松弛效应研究

Skeletal muscle relaxation effect of cisatracurium on asymptomatic human immunodeficiency virus-infected patients under intravenous general anesthesia

目的评价无症状人类免疫缺陷病毒(HIV)感染患者全凭静脉麻醉中顺阿曲库铵的骨骼肌松弛效应。方法选取2019年1月至2020年6月于首都医科大学附属北京地坛医院择期全凭静脉麻醉下行腹腔镜胆囊切除手术患者80例,其中无症状HIV感染患者40例(HIV组)、无HIV感染患者40例(对照组)。2组均静脉注射顺阿曲库铵0.15 mg/kg。记录2组一般资料、手术时间、麻醉时间。比较2组骨骼肌松弛效应、术中血流动力学及脑电双频指数(BIS)。采用改良气管插管方法评价气管插管条件。结果2组男性比例、年龄、体质量、身高、手术时间、麻醉时间比较,差异均无统计学意义(均P>0.05)。HIV组顺阿曲库铵骨骼肌松弛起效时间、恢复时间、恢复指数与对照组比较[(4.0±0.9)min比(3.8±1.1)min、(34±3)min比(32±5)min、(14.1±2.4)min比(13.2±3.4)min],差异均无统计学意义(均P>0.05)。HIV组气管插管前、气管插管后、拔管前、拔管后各时点心率、平均动脉压、BIS与对照组比较,差异均无统计学意义(均P>0.05)。HIV组气管插管条件优38例、良2例,对照组气管插管条件优37例、良3例,组间比较差异无统计学意义(P=0.35)。结论顺阿曲库铵骨骼肌松弛效应及术中血流动力学变化在无症状HIV感染患者和普通患者全凭静脉麻醉中未见明显差异,顺阿曲库铵作为无症状HIV感染患者手术的麻醉用药较为安全。

Objective To evaluate the skeletal muscle relaxation effect of cisatracurium on asymptomatic human immunodeficiency virus(HIV)-infected patients under intravenous general anesthesia.Methods From January 2019 to June 2020,80 HIV-infected patients undergoing elective laparoscopic cholecystectomy under intravenous general anesthesia in Beijing Ditan Hospital,Capital Medicial University were enrolled,including40 asymptomatic HIV-infected patients(HIV group)and 40 patients without HIV infection(control group).Both groups were given 0.15 mg/kg cisatracurium intravenous injection.The general data,operation time and anesthesia time of both groups were recorded.The skeletal muscle relaxation,and hemodynamics and bispectral index(BIS)during operation were compared between the two groups.Modified endortacheal intubation method was used to evaluate the conditions of endotracheal intubation.Results There were no significant differences in male rate,age,body mass,height,operation time and anesthesia time between the two groups(all P>0.05).The onset time,recovery time and recovery index of skeletal muscle relaxation caused by cisatracurium in HIV group had no significant differences compared with control group[(4.0±0.9)min vs(3.8±1.1)min,(34±3)min vs(32±5)min,(14.1±2.4)min vs(13.2±3.4)min](all P>0.05).The heart rate,mean arterial pressure and BIS before endotracheal intubation,after endotracheal intubation,before extubation and after extubation in HIV group had no significant differences compared with control group(all P>0.05).The conditions of endotracheal intubation were excellent in 38 patients,good in 2 patients in HIV group and excellent in 37 patients,good in 3 patients in control group,and there was no significant difference between the two groups(P=0.35).Conclusions The skeletal muscle relaxation effect of cisatracurium and intraoperative hemodynamic changes have no significant differences between asymptomatic HIV-infected patients and patients without HIV infection under intravenous general anesthesia.Cisatracurium is safe as an anaesthetic drug for surgery in asymptomatic HIV-infected patients.