顺式阿曲库铵闭环靶控输注与持续输注对胆囊切除术病人MAP、HR、SpO_(2)及肌松药物用量的影响

Effects of closed-loop target controlled infusion and continuous infusion of cis-atracurium on MAP,HR,SpO_(2) and muscle relaxant dosage in patients undergoing cholecystectomy

目的:探讨顺式阿曲库铵闭环靶控输注与持续输注对胆囊切除术病人平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_(2))及肌松药物用量的影响。方法:胆囊切除术病人中90例,以抽签法分为对照组(n=45)和观察组(n=45),对照组采用顺式阿曲库铵持续输注,观察组采用顺式阿曲库铵闭环靶控输注,对比2组诱导前(T_(1))、插管后5 min(T_(2))、拔管前1 min(T_(3))、拔管后2 min(T_(4))、拔管后24 h(T_(5))MAP、HR、SpO_(2)、ETCO_(2),肌松情况、术后恢复情况、并发症发生率。结果:同组内病人不同时间点的MAP和HR水平比较均显示,与T_(1)时相比,T_(2)时明显降低(P<0.01),T_(3)时升高(P<0.01),而后逐渐恢复到T_(1)水平(P>0.05);组间比较显示,不同时间点2个指标的水平差异均无统计学意义(P>0.05)。同组内病人不同时间点的SpO_(2)和ETCO_(2)水平比较显示,各时间点水平均无明显变化(P>0.05),组间比较显示,仅在T_(1)时间点,观察组病人ETCO_(2)水平略高于对照组(P<0.05),其他时间SpO_(2)和ETCO_(2)水平组间差异均无统计学意义(P>0.05)。观察组肌松药物起效时间、持续时间和苏醒时间均短于对照组(P<0.01),2组拔管时间差异无统计学意义(P>0.05)。结论:顺式阿曲库铵闭环靶控输注与持续输注对胆囊切除术均具有很好效果,但前者肌松药物用量更少,效果更明显。

Objective:To explore the effects of closed-loop target controlled infusion and continuous infusion of cis-atracurium on mean arterial pressure(MAP),heart rate(HR),blood oxygen saturation(SpO_(2))and muscle relaxant dosage in patients undergoing cholecystectomy.Methods:Ninety patients with cholecystectomy were divided into the control group(n=45)and observation group(n=45)by lot.The control group was continuously infused with cis-atracurium,and the observation group was infused with cis-atracurium by closed-loop target controlled infusion.MAP,HR,SpO_(2),ETCO_(2),muscle relaxation state,postoperative recovery state and incidence of complication before induction(T_(1)),5 minutes after intubation(T_(2)),1 minute before extubation(T_(3)),2 minutes after extubation(T_(4)),24 hours after extubation(T_(5))were compared between the two groups.Results:The comparison of MAP and HR levels of patients in the same group at different time points showed that compared with T_(1),the levels of MAP and HR decreased significantly at T_(2)(P<0.01),increased at T_(3)(P<0.01),and then gradually recovered to the levels at T_(1)(P>0.05);the comparison between groups showed that there was no significant difference in the levels of the two indicators at different time points(P>0.05).The comparison of SpO_(2) and ETCO_(2) levels of patients in the same group at different time points showed that there was no significant change at each time point(P>0.05);the comparison between groups showed that only at T_(2) time point,the ETCO_(2) level of patients in the observation group was slightly higher than that in the control group(P<0.05),and there was no significant difference in SpO_(2) and ETCO_(2) levels between the two groups at other time points(P>0.05).The onset time,duration time and recovery time of muscle relaxant in the observation group were shorter than those in the control group(P<0.01),and there was no significant difference in the extubation time between the two groups(P>0.05).Conclusions:Both closed-loop target controlled infusion and continuous infusion of cis-atracurium have good effects on cholecystectomy,but the former has less muscle relaxant dosage and is more effective.