颅内动脉瘤栓塞术中持续泵注米库氯铵安全性及有效性分析

Analysis of the safety and efficacy of continuous injection of mivacurium chloride during intracranial aneurysm embolization

目的探讨颅内动脉瘤栓塞术中持续泵注米库氯铵的安全性及有效性。方法选取2023年4—10月于北部战区总医院择期行颅内动脉瘤栓塞术的60例患者为研究对象。采用随机数字表法将患者分为米库氯铵组(M组)与罗库溴铵组(L组),每组各30例。两组患者麻醉诱导均给予舒芬太尼0.20~0.40μg/kg+丙泊酚2.00~4.00 mg/kg;M组给予米库氯铵0.25 mg/kg,L组给予罗库溴铵0.60 mg/kg。诱导完成后置入喉罩,术中维持两组均采用静吸复合麻醉,M组术中持续泵注米库氯铵0.3 mg/(kg·h),L组间断注射罗库溴铵0.2 mg/kg。观察两组患者给药前、给药5 min、给药15 min的血浆组胺浓度,肌松起效时间,置入喉罩即刻、15 min、30 min、45 min气道压和循环变化情况,手术时间,拔除喉罩时间,不良反应发生情况及术者满意度。结果M组给药5 min、15 min的血浆组胺浓度高于L组,差异有统计学意义(P<0.05)。M组给药5 min、15 min的血浆组胺浓度高于给药前,差异有统计学意义(P<0.05)。M组置入喉罩45 min气道压低于L组,差异有统计学意义(P<0.05)。两组置入喉罩即刻、15 min、30 min、45 min的平均动脉压、心率比较,差异无统计学意义(P>0.05)。M组拔除喉罩时间短于L组,术者满意度高于L组,差异有统计学意义(P<0.05)。两组患者肌松起效时间、不良反应发生率比较,差异无统计学意义(P>0.05)。结论颅内动脉瘤栓塞术中持续泵注米库氯铵安全有效,未引起严重不良反应,同时增加了术者的满意度。

Objective To investigate the safety and efficacy of continuous injection of mivacurium chloride during intracranial aneurysm embolization.Methods A total of 60 patients who underwent intracranial aneurysm embolization from April to October 2023 in General Hospital of Northern Theater Command were selected as the study objects.Patients were divided into mivacurium chloride group(group M)and rocuronium bromide group(group L)by random number table method,with 30 cases in each group.Both groups were given sufentanil 0.20~0.40μg/kg+propofol 2.00~4.00 mg/kg for anesthesia induction.Group M was given 0.25 mg/kg mivacurium chloride and group L was given 0.60 mg/kg rocuronium bromide.After induction,laryngeal mask was inserted and intraoperative maintenance was maintained in both groups.The group M was continuously injected with 0.3 mg/(kg·h)of mivacurium chloride,and the group L was intermittently injected with 0.2 mg/kg of rocuronium.Plasma histamine concentrations were observed before,5 minutes and 15 minutes of administration in the two groups.The changes of airway pressure and circulation were observed immediately,15 minutes,30 minutes and 45 minutes after laryngeal mask placement in two groups.The onset time of muscle relaxation,operation time,removal time of laryngeal mask,occurrence of adverse reactions and operator satisfaction were compared between the two groups.Results The plasma histamine concentrations in group M at 5 minutes and 15 minutes were higher than those in group L,and the differences were statistically significant(P<0.05).The plasma histamine concentrations of group M at 5 minutes and 15 minutes was higher than that before administration,and the difference was statistically significant(P<0.05).The airway pressure in group M was lower than that in group L 45 minutes after laryngeal mask placement,and the difference was statistically significant(P<0.05).There was no significant difference in mean arterial pressure and heart rate immediately,15 minutes,30 minutes and 45 minutes between the two groups after laryngeal mask implantation(P>0.05).The removal time of laryngeal mask in group M was shorter than that in group L,and the satisfaction of the surgeon was higher than that in group L,the difference was statistically significant(P<0.05).There was no significant difference in onset time of muscle relaxation and incidence of adverse reactions between the two groups(P>0.05).Conclusion Pumping of micuronium chloride during intracranial aneurysm embolization is safe and effective,without serious adverse reactions,and can increase the satisfaction of the surgeon.