摘要
目的观察择期喉科全麻手术患者在麻醉后恢复室(PACU)肌松药残余神经肌肉阻滞作用(RNMB)的发生情况,为提高喉科围手术期患者安全提供参考。方法收集2020年7月至2021年3月在首都医科大学附属北京同仁医院接受喉科手术的成年患者,根据使用肌松药种类将患者分为罗库溴铵组、米库氯铵组和顺阿曲库铵组,记录并分析不同组别患者的一般情况[年龄、体重指数、美国麻醉医师协会(ASA)分级等],手术时长、麻醉时长和在PACU停留时间,神经肌肉功能恢复情况(用TOFr表示),并记录患者在PACU言语和抬头能力,以及胃食管反流、误吸、呼吸困难等不良事件的发生情况。结果纳入本研究的患者共320例,男性188例(58.8%),女性132例(41.2%);年龄(50±13)岁;手术时间(38.6±30.1)min;麻醉时间(57.2±32.8)min;PACU停留时间(34.6±11.4)min。罗库溴铵组、米库氯铵组和顺阿曲库铵组患者分别为115、141和64例,3组患者年龄、体重指数、ASA分级的差异均无统计学意义(均P>0.05)。米库氯铵组麻醉时长和手术时长均短于罗库溴铵组和顺阿曲库铵组[(43.53±23.90)min比(67.54±37.72)min和(68.84±29.34)min;(26.87±22.18)min比(47.16±34.83)min和(48.84±27.57)min],差异均有统计学意义(均P<0.01)。3组患者在PACU停留时间差异无统计学意义(P>0.05)。入PACU即刻,320例患者中TOFr<0.9者272例(88.6%),其中TOFr<0.7者105例(32.8%);离开PACU时,所有患者的TOFr均>0.9。除出PACU时点外,罗库溴铵组各时点TOFr均高于顺阿曲库铵组,差异均有统计学意义(均P<0.01);除入PACU即刻和出PACU 2个时点外,米库氯铵组TOFr均高于顺阿曲库铵组,差异有统计学意义(均P<0.01);米库氯铵组入PACU即刻和入PACU 5 min时TOFr均低于罗库溴铵组,差异有统计学意义(均P<0.05)。入PACU时,320例患者中有79例(24.7%)血氧饱和度(SpO_(2))<0.95,3组患者SpO_(2)的差异有统计学意义(P=0.029),其中顺阿曲库铵组SpO_(2)<0.90者4例(6.25%),低氧血症发生率高于另外2组。3组患者入PACU时言语和抬头能力的差异均有统计学意义(P=0.036,P<0.001)。所有患者在PACU内均未发生反流、误吸、呼吸困难等不良事件。结论喉科手术患者术后进入PACU即刻RNMB发生率较高且严重,随时间延长TOFr逐渐升高,RNMB逐渐减退;使用顺阿曲库铵的患者术后RNMB发生率较高且程度较重。PACU内常规监测和神经肌肉监测有益于患者围手术期安全。
Objective To observe the occurrence of residual neuromuscular blockade(RNMB)in post anesthesia care unit(PACU)in patients undergoing selective laryngeal surgery under general anesthesia and provide reference for improving the safety of muscle relaxants during the perioperative period.Methods The adult patients who underwent laryngeal surgery in Beijing Tongren Hospital,Capital Medical University from July 2020 to March 2021 were collected.According to the muscle relaxants used in the surgery,the patients were divided into rocuronium bromide group,mivacurium chloride group,and cisatracurium group.The general information of patients in the different groups[age,body mass index,American Society of Anesthesiologists(ASA)classification,etc.],duration of surgery,anesthesia time,stay time in PACU,and recovery of neuromuscular function(expressed using train of four ratio,abbreviated as TOFr)were recorded and analyzed.The ability to speak and raise one′s head in PACU,as well as the occurrence of adverse events such as gastroesophageal reflux,aspiration,and dyspnea were also recorded.Results A total of 320 patients were enrolled in the study,including 188 males(58.8%)and 132 females(41.2%),with a mean age of(50±13)years.The duration of surgery was(38.6±30.1)minutes,anesthesia time was(57.2±32.8)minutes,and stay time in PACU was(34.6±11.4)minutes.There were 115,141,and 64 patients in the rocuronium bromide,mivacurium chloride,and cisatracurium groups,respectively.The differences in age,body mass index,and ASA grade in patients among the 3 groups were not significant(all P>0.05).The anesthesia time and duration of surgery in patients of the mivacurium chloride group were shorter than those of the rocuronium bromide and cisatracurium groups[(43.53±23.90)minutes vs.(67.54±37.72)minutes and(68.84±29.34)minutes;(26.87±22.18)minutes vs.(47.16±34.83)minutes and(48.84±27.57)minutes],and the differences were statistically significant(all P<0.01).The difference in stay time in PACU among the 3 groups was not statistically significant(P>0.05).At the moment of entering PACU,272(88.6%)of 320 patients had TOFr<0.9,of which 105(32.8%)had TOFr<0.7;when leaving PACU,the TOFr of all patients was>0.9.Except the time point of leaving PACU,TOFr in the rocuronium bromide group at the other time points were higher than those in the cisatracurium group(all P<0.01).Except the 2 time points of the moment of entering and leaving PACU,TOFr in the mivacurium chloride group was higher than those in the cisatracurium group(all P<0.01).At the moment of entering PACU and 5 minutes after entering PACU,TOFr in the mivacurium chloride group was lower than those in the rocuronium bromide group(all P<0.05).When entering PACU,79 of 320 patients had saturation of pulse oximetry(SpO_(2))<0.95 and the difference in SpO_(2) among the 3 groups was statistically significant(P=0.029),of which 4 cases(6.25%)had SpO_(2)<0.90 in the cisatracurium group,and the incidence of hypoxemia was higher than that in the other 2 groups.The differences in ability of speach and head lifting of patients among the 3 groups when entering PACU were statistically significant(P=0.036,P<0.001).No adverse events such as reflux,or aspiration,dyspnea occurred in patients in PACU.Conclusions The incidence of RNMB in patients undergoing laryngeal surgery entering PACU immediately is high and the degree of RNMB is more severe,with TOFr gradually increasing and RNMB decreasing over time.The patients who receive cisatracurium have a high incidence and severity of postoperative RNMB.Routine monitoring and neuromuscular monitoring in PACU are beneficial for patients′perioperative safety.
作者
林娜
赵萌萌
王古岩
Lin Na;Zhao Mengmeng;Wang Guyan(Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)
出处
《药物不良反应杂志》
CSCD
2023年第6期332-338,共7页
Adverse Drug Reactions Journal
基金
北京市医院管理中心临床医学发展专项(ZYLX202103)
北京市医院管理中心“登峰”计划(DFL20220203)。
关键词
耳鼻喉外科手术
麻醉
全身
麻醉恢复期
安全
神经肌肉非去极化药
Otorhinolaryngologic surgical procedures
Anesthesia,general
Anesthesia recovery period
Safety
Neuromuscular nondepolarzing agents
