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顺式阿曲库铵闭环注射系统在胸腔镜手术中的应用
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DOI:
作者:
李冰 薛纪秀 叶新 马艳辉 尹橙 阎雁宏
LI bing ,XUE ji-xiu, YE xin, Ma Yanhui, Yin Cheng, Yan Yanhong
作者单位:
首都医科大学宣武医院麻醉科
Department of Anesthesiology, Beijing Xuanwu Hospital
关键词:
肌松监测;闭环肌松注射系统;肌松持续输注方式;顺式阿曲库铵;胸腔镜手术
Neuro-muscular monitoring; Closed-loop muscle relaxant injection system ; continuous injection mode ; Cis-atracurium; thoracoscopic surgery
摘要:
研究闭环肌松注射方式对药物剂量及患者肌松恢复情况的影响。方法 选择胸腔镜手术患者20例,再随机均分成闭环注射组(G组)和对照组(C组)。C组维持顺式阿曲库铵 1.5~2μg/kg•min-1,此时肌松最大抑制程度(T1)能达到89~99%,直至手术结束前30分钟;G组顺式阿曲库铵背景量0.08μg/kg•min-1,设定肌松深度反馈值T1=25%。记录患者麻醉时间、手术时间、顺式阿曲库铵的总用量、恢复指数、恢复时间、TOFr75恢复时间及TOFr90恢复时间。结果 G组顺式阿曲库铵总用量明显少于C组(P<0.05),恢复时间、恢复指数、TOFr75恢复时间及TOFr90恢复时间,明显缩短(P<0.05)。结论 与持续输注方式相比,闭环肌松药注射方式可以满足胸腔镜手术中的肌松要求,使肌松药物的用量减少,缩短肌松恢复时间,实现肌松药个性化和合理化使用。
Objective To explore the effect of closed-loop muscle relaxant injection system on the dosage of muscle relaxant and the neuro-muscular recovery. Methods 20 patients, who were scheduled to accept thoracoscopic surgery, were enrolled in this study. All the Patients were randomly divided into two subgroups (n=10)--continuous infusion group(C) and guidance group(G). The ram velocity of Cis-atracurium was kept at 1.5-2μg/kg.min-1 in group C until 30 minutes before the end of surgery. Meanwhile the maximal T1 depression could be kept between 89% to 99%. Keeping the ram velocity of Cis-atracurium at 0.8μg/kg.min-1 in group G, and setting the feedback value of muscle relaxation depth at 25%. Reserchers withdrew the relaxant according to the monitoring information nearby the end of surgery. The duration of anesthesia, the total amount of Cis-atracurium, recovery index(RI), recovery time, TOFr75, and TOFr90 were recorded. Results The total amount of Cis-atracurium in group G was more than group C; the differences was statistically significant(p<0.05). Recovery time, RI, TOFr0.75 and TOFr0. 90 of group G were all significantly shorted(p<0.05) than that of group C. Conclusion Compared to the continuous injection mode, the closed-loop injection system could meet the muscle relaxants requirements of the thoracoscopic surgery , and the dosage of drugs was less, the time of muscle relaxation was shorter. The closed-loop muscle relaxant injection system could personalize and rationalize the muscle relaxant usage.
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