摘要
目的比较行腹腔镜下胃肠肿瘤手术的老年患者间断与持续静脉注射顺阿曲库铵两种不同给药方式对肌肉松弛效应的影响。方法选择在全身麻醉下行腹腔镜下胃肠肿瘤手术的老年患者60例,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,随机分入间断给药组和持续给药组,每组30例。麻醉诱导后,间断给药组患者根据手术需要间断静脉给药,持续给药组患者经静脉输液泵持续给药,应用肌肉松弛监测仪观察术中肌肉松弛情况,当4个成串刺激(TOF)中第1个颤搐幅度(T1)恢复至10%时,间断给药组患者静脉注射顺阿曲库铵0.03mg/kg,持续给药组经静脉输液泵注射阿曲库铵1.4\mg·kg-1·min-1。监测麻醉诱导后T1首次恢复到10%的时间(10%时间)、最后1次给药(停止持续给药)至TOF恢复到70%的时间(70%时间)、TOF从70%恢复到90%的时间(90%时间)、恢复指数(TOF从25%恢复至75%的时间)和肌肉松弛药总用药量。结果两组间手术时间、10%时间、90%时间的差异均无统计学意义(P值均>0.05)。持续给药组的70%时间显著短于间断给药组(P<0.01),恢复指数、总用药量和平均静脉注射速度均显著低于间断给药组(P值分别<0.05、0.01)。结论持续静脉注射顺阿曲库铵能减少老年患者行腹腔镜下胃肠肿瘤手术时的顺阿曲库铵用药量,有利于术后肌肉松弛的恢复。
Objective To compare the effect of intermittent injection versus continuous infusion of cisatracurium on muscle relaxation in laparoscopic surgery for gastrointestinal tumor in elderly patients. Methods Sixty elderly patients （American Society of Anesthesiologists I or Ⅱ ） with gastrointestinal tumor treated by laparoscopic surgery under general anesthesia were randomly divided into two groups （n = 30）. After induction of anesthesia, cisatracurium was intravenously injected when needed in group A and infused continuously by microinfusion pump in group B. Neuromuscular block was monitored using train of 4 stimulation （TOF） watch SX Monitoring during operation. When the first twitch （T1） recovered to 10% after induction, 0. 03 mg/kg cisatracurium was injected in group A, while in group B, 1.4 μg·kg^-1·min^-1 was given continously when T1 recoverd to 10% cisatracurium was added in group A and the speed of infusion in group B was adjusted. Recovery time of TOF to 70% and 90%, recovery index and total dose of muscle relaxants were recorded. Results There were no significant differences in operation time, recovery time of T1 to 10%, or recovery time of TOF to 90% between two groups （all P〉0.05）. The consumption of cisatracurium, recovery time of TOF to 70 % and recovery index in group B were significantly less than those in group A （P 〈0.05, 0.01 ）. Conclusion Continuous intravenous infusion can reduce the total amount of cisatracurium in laparoscopic surgery in elderly patients with gastrointestinal tumor, which is beneficial to the postoperative recovery of muscular relaxation.
出处
《上海医学》
CAS
CSCD
北大核心
2015年第6期500-502,共3页
Shanghai Medical Journal
基金
上海市嘉定区医学重点学科(嘉卫[2009]3号
ZD01)
2013年度上海市嘉定区科学技术委员会基金(KWKYXM 2013-KW-14)资助项目
关键词
顺阿曲库铵
间断静脉注射
持续静脉输注
腹腔镜下胃肠肿瘤手术
肌肉松驰
老年患者
Cisatracurium
Intermittent injection
Continuous infusion
Laparoscopic surgery for gastrointestinal tumor
Neuromuscular relaxation
Elderly patients
