摘要
目的观察神经外科患者术后残余肌松发生情况及其呼吸功能状态。方法选择神经外科择期全身麻醉开颅手术、术后转入麻醉后恢复室（PACU）的患者328例，ASA分级Ⅰ-Ⅱ级，采用随机数字表法将患者分为维库溴铵组（135例）和罗库溴铵组（193例）。麻醉诱导后气管内插管，持续输注丙泊酚吸入七氟烷并间断给予肌肉松弛剂维持麻醉。术毕根据临床拔管指征拔除气管内导管转入PACU，使用4个成串刺激（TOF）比值测定肌力恢复情况和动脉血气分析，并对其进行比较。结果维库溴铵组和罗库溴铵组患者术后残余肌松发生率分别为31．9％（43／135）、14．5％（28／193）。维库溴铵组TOF比值＜0．9与TOF比值≥0．9的低氧血症和高碳酸血症的发生率分别为7．0％（3／43）比4．3％（4／92）和44．2％（19／43）比18．5％（17／92）（P＜0．01）；罗库溴铵组TOF比值＜0．9与TOF比值≥0．9的低氧血症和高碳酸血症的发生率分别为3．6％（1／28）比1．2％（2／165）和39．3％（11／28）比17．0％（28／165）（P＜0．01）。结论神经外科患者依据临床指征拔管后残余肌松发生率较高，且呼吸功能受损。
Objective To investigate the incidence of postoperative residual paralysis and respiratory function of patients undergoing neurosurgical anesthesia. Methods Three hundred and twenty-eight patients undergoing neurosurgical anesthesia （ASA Ⅰ - Ⅱ ） were divided into vecuronium group （135 cases） and rocuronium group （193 cases） by random digits table. Anesthesia was maintained with propofol in combination with sevoflurane and intermittented intravenous infusion boluses of muscle relaxatant. Extubation of the intratracheal tube in operation room was performed under clinical criteria. The neuromuscular function were detected by acceleromyography with supramaximal train-of- four（TOF） stimulation of the ulnar nerve, and pulmonary function were measured in postanesthesia care unit （PACU）. The TOF ratio and pulmonary function were compared between two groups. Results The incidence of postoperative residual paralysis was 31.9%（43/135） in vecuronium group,and 14.5% （28/193） in rocuronium group. Hypoxemia and hypercapnia occurred in vecuronium group with TOF〈 0.9 were higher than in those with TOF ≥0.9 [7.0%（3/43 ） vs. 4.3%（4/92） and 44.2%（ 19/43 ） vs. 18.5%（17/92） ,P 〈0.01 ] ,while in rocuronium group with TOF 〈 0.9 were higher than in those with TOF ≥ 0.9 [ 3.6% （ 1/28 ） vs. 1.2% （2/165） and 39.3% （ 11/28 ） vs. 17.0%（28/165）,P 〈 0.01 ]. Conclusions There is a high incidence of postoperative residual paralysis according to the clinical criteria of recovery of neuromuscular function of patients undergoing neurosurgical anesthesia , which would impair respiratory function.
出处
《中国医师进修杂志》
2012年第11期8-10,共3页
Chinese Journal of Postgraduates of Medicine
关键词
肌松弛
维库溴铵
罗库溴铵
呼吸功能试验
神经外科手术
Muscle relaxation
Vecuronium
Rocumnium
Respiratory function tests
Neurosurgical procedures
