摘要
目的 观察顺式阿曲库铵用于肥胖患者的肌松作用. 方法 选择 ASAⅠ - Ⅱ级、BMI≥35 kg/m2择期行腹腔镜胃减容（ sleeve）手术的患者20例,随机分为IBW组和TBW组. ASAⅠ-Ⅱ级择期行腹腔镜胆总管探查、T管引流术、BMI 20-24 kg/m2 的10 例患者为对照组,IBW组按照理想体重、TBW组与对照组按照总体重分别给予0. 15 mg/kg顺苯磺阿曲库铵,采用肌松监测仪进行拇内收肌肌松监测. 采用静脉快速诱导麻醉、静脉复合笑气维持麻醉. 记录肌松药的起效时间[肌松药注毕后到T1 抑制达到90%的时间（ TOF中T2消失时） ]、肌松药的持续时间（ T1 消失到T1%恢复到对照25%的时间）及气管插管条件评级. 结果 TBW组起效时间明显短于IBW组和对照组（P〈0. 05）,IBW组与对照组比较差异无统计学意义（P〉0. 05）;TBW组的持续时间长于对照组,IBW组的持续时间短于对照组,两组比较差异有统计学意义（ P〈0. 05 ）,三组的插管条件比较差异无统计学意义（P〉0. 05）. 结论 择期行胃束带减容术的病态肥胖患者采用丙泊酚、瑞芬太尼复合笑气麻醉,所需顺苯磺阿曲库铵的剂量应该按照IBW计算,虽然延长起效时间,但不影响插管条件和手术操作,同时缩短了肌松恢复时间,不会造成肌松残余,有很好的临床应用价值.
Objective To observe the effect of cisatracurium on obese patients with muscle relaxa-tion. Methods Twenty ASAⅠ ~ Ⅱpatients （ BMI =35 kg/m2 ） undergoing laparoscopic gastric volume reduction （ sleeve） operation were randomly divided into IBW group and TBW group. Ten ASAⅠ~Ⅱpatients undergoing lapa-roscopic common bile duct exploration and T tube drainage （ BMI 20 ~ 24 kg/m2 ） were chosen as control group. Patients in IBW group were given 0. 15 mg/kg cisatracurium besilate according to the ideal body weight,and pa-tients in TBW group and control group were given 0. 15 mg/kg cisatracurium besilate according to the total body weight. The adductor pollicis muscle relaxation was monitored by muscle relaxation monitor. The rapid vein induction of anesthesia and the maintenance anesthesia of intravenous combined with nitrous oxide were given. The onset time of muscle relaxants （ finishing muscle relaxant injection to the inhibition of T1 reached 90%） （ T2 disappeared in TOF）,the duration of muscle relaxants （ disappearance of T1 to the T1% returned to 25% of control） and the tracheal intuba-tion condition were recorded. Results The onset time of TBW group was shorter than those of IBW group and control group （P〈0. 05）,no significant difference was observed between IBW group and control group （P〉0. 05）. Com-pared with control group,the duration of TBW group was longer （P〈0. 05）,and the duration of IBW group was shor-ter （ P 0. 05）. Conclusion The dosage of cisatracurium besilate for morbidly obese patients undergoing laparoscopic ad-justable gastric banding （ LAGB） with combined anesthesia of propofol,remifentanil and nitrous oxide should be calcu-lated according to the IBW. Although the onset time is prolonged,but the intubation condition and operation are not af-fected,and the recovery time of muscle relaxation is shortened without residual muscular relaxation,it has good clinical application value.
出处
《实用药物与临床》
CAS
2015年第10期1207-1211,共5页
Practical Pharmacy and Clinical Remedies
关键词
病态肥胖
腹腔镜手术
全身麻醉
Morbidly obesity
Laparoscopic operation
General anesthesia
