米库氯铵用于老年患者经皮球囊压迫术快速麻醉恢复的临床观察

Clinical observation of mivacurium on rapid anesthesia recovery in elderly patients after percutaneous balloon compression

目的评价单次静注米库氯铵用于老年患者经皮球囊压迫术(PBC)的临床效果。方法选择2020年1月至2021年1月拟行PBC手术老年患者60例,年龄65~75岁,体重50~75 kg,ASAⅡ或Ⅲ级,随机分为2组:米库氯铵组(M组)和顺式阿曲库铵组(S组),每组30例。麻醉诱导依次静脉注射舒芬太尼0.2μg/kg、依托咪酯0.2 mg/kg,患者入睡后M组静注米库氯铵0.2 mg/kg,S组静注顺式阿曲库铵0.15 mg/kg,气管插管后行机械通气,维持P_(ET)CO_(2)35~45 mm Hg,静脉输注丙泊酚及瑞芬太尼维持麻醉。记录2组患者气管插管时间、临床时效、恢复指数和气管拔管时间;记录气管拔管后30 min肌松残余及麻醉后恢复室(PACU)停留>40 min的发生率;分别在给予肌松药前、给药后3 min和气管插管后5 min,采集静脉血测定血浆组铵(HIS)浓度,同时记录患者皮肤潮红、心动过速和低血压的发生率。结果与S组相比,M组患者的气管插管时间、临床时效、恢复指数及气管拔管时间均显著降低(P<0.05);M组患者肌松残余及PACU停留>40 min的发生率均下降(P<0.05);与S组相比,M组患者给予肌松药后3 min的血浆HIS浓度升高(P<0.05),血浆HIS释放程度为Ⅰ级的患者例数增加(P<0.05),但血浆HIS释放程度Ⅱ、Ⅲ级的患者例数2组比较差异无统计学意义(P>0.05)。结论米库氯铵可安全用于老年患者PBC手术,加速麻醉术后恢复,降低肌松残余的发生率。

Objective To evaluate the effect of a single intravenous injection of mivacurium on elderly patients treated with percutaneous balloon compression(PBC).Methods A total of 60 elderly patients with 65-75 years of age,50-75kg of body weight and the American Society of Anesthesiologists(ASA)physical statue classification of classⅡ-Ⅲ,who were treated with the elective PBC from January 2020 to January 2021 were recruited.They were randomly divided into group mivacurium(group M)and group cis-atracurium(group S),with 30 cases in each group.Intravenous injection of sufentanil 0.2μg/kg and etomidate 0.2mg/kg was performed for anesthesia induction.Patients in group M were given a single intravenous injection of mivacurium 0.2mg/kg,while those in group S were intravenously injected with cis-atracurium 0.15 mg/kg after sleep.Mechanical ventilation was performed after orotracheal intubation and the end-tidal carbon dioxide partial pressure(PetCO 2)was maintained within 35-45mmHg.Intravenous infusion of propofol and remifentanil was used during anesthesia maintenance.Time for intubation,clinical efficacy,recovery index(RI),time for extubation,and the incidence of residual neuromuscular blockade 30min after extubation,and length of stay in post-anesthesia care unit(PACU)for over 40min were recorded.Intravenous blood samples were collected immediately before injection of muscle relaxant,3 minutes after injection and 5 minutes after endotracheal intubation.Plasma histamine(HIS)concentration was determined by high performance liquid chromatography.The incidence of flushed skin,tachycardia,and hypotension were recorded after injection of muscle relaxant.Results Compared with group S,the time for intubation,metabolic time,RI,time for extubation and the incidence of residual neuromuscular blockade 30min after extubation,and length of stay in PACU for over 40min were significantly lower in group M(P<0.05).Compared with group S,HIS concentration 3min after muscle relaxant injection was significantly higher in group M(P<0.05).The number of patients with class I HIS release was significantly higher in group M than that of group S(P<0.05),while that of classⅡandⅢwas comparable between groups(P>0.05).Conclusion Mivacurium can be safely used in elderly patients treated with PBC,which accelerates the recovery after anesthesia and reduces incidence of residual neuromuscular blockade.