摘要
目的利用序贯法探讨持续输注米库氯铵用于不影响全凭静脉麻醉下甲状腺手术术中神经功能监测的最大输注剂量,并观察其不良反应。方法纳入30例进行甲状腺手术术中神经功能监测的患者序贯地进行试验。术中以丙泊酚复合瑞芬太尼维持麻醉深度。手术中当4个成串刺激比值升至90%以上时开始持续输注米库氯铵,以14.97μg·kg-1·min-1为起始剂量,根据前1例患者对神经功能监测仪的反应来上调或者下调下1例患者的米库氯铵输注剂量。通过Brownlee上下序贯法来计算求得米库氯铵的EC50及95%CI。术中观察是否体动、皮肤潮红情况,记录对比诱导注射肌松药即刻(T0)、诱导肌松药给药5 min(T1)、术中输注肌松药即刻(T2)、术中输注肌松药10 min(T3)、术中输注肌松药20 min(T4)5个时点平均动脉压和心率。结果持续输注米库氯铵且不影响全凭静脉麻醉下甲状腺手术术中神经功能监测的EC50为18.9μg·kg-1·min-1,95%可信区间为17.3~20.5μg·kg-1·min-1。1例(3.3%)患者诱导后出现一过性双脸颊皮肤发红,所有患者均未出现插管困难及术中体动,T0、T1、T2、T、T4任意两时点平均动脉压值两两比较、任意时点心率值两两比较,差异无统计学意义(P>0.05)。结论采用全凭静脉麻醉维持的甲状腺手术中,持续输注米库氯铵且不影响甲状腺手术术中神经功能监测的EC50为18.9μg·kg-1·min-1,95%可信区间为17.3~20.5μg·kg-1·min-1。术中未见严重不良反应。
Objective To investigate the maximum dose of continuous mivacurium infusion for intraoperative neuromonitoring(IONM)and observe the adverse reactions during thyroid surgery under total intravenous anesthesia(TIVA).Methods Thirty patients undergoing IONM during thyroid surgery received continuous infusion of mivacurium at the initial rate of 14.97μg·kg-1·min-1.The infusion rate was adjusted in the next patient based on the response of the previous patient in IONM.The depth of anesthesia was maintained with propofol and remifentanil during the surgery.The EC50 and 95%CI of mivacurium were calculated with Brownlee's up-and-down sequential method.During the operation,body movement and skin flushing of patient was monitored,and the mean arterial pressure(MAP)and heart rate(HP)were recorded immediately(T0)and at 5 min(T1)after injection of muscle relaxant for anesthesia induction,immediately(T2)and at 10 min(T3)and 20 min(T4)after initiation of intraoperative infusion of the muscle relaxant.Results The EC50 for continuous infusion of mivacurium without affecting IONM was 18.9μg·kg-1·min-1(95%CI:17.3-20.5μg·kg-1·min-1)during thyroid surgery under TIVA.One patient(3.3%)developed transient facial skin redness after induction.Intubation difficulties or body motions occurred in none of the patients during the surgery.Pair-wise comparison showed no significant variations in MAP or HR of the patients at the 5 time points(P>0.05).Conclusion In patients undergoing thyroid surgery under TIVA,the EC50 for continuous infusion of mivacurium is 18.9μg·kg-1·min-1(95%CI:17.3-20.5μg·kg-1·min-1),which does not affect IONM or causes serious adverse reactions during the operation.
作者
陈永杰
王博
姚兰
冯泽国
CHEN Yongjie;WANG Bo;YAO Lan;FENG Zeguo(Pain Department,The First Medical Center of PLA General Hospital,Beijing 100853,China;Anesthesiology Department,Peking University International Hospital,Beijing 102206,China)
出处
《南方医科大学学报》
CAS
CSCD
北大核心
2021年第1期64-68,共5页
Journal of Southern Medical University
基金
军队保健课题(15BJZ36)。
关键词
米库氯铵
甲状腺手术
术中神经监测
全凭静脉麻醉
mivacurium
thyroid surgery
intraoperative neuromonitoring
total intravenous anesthesia
