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| 新斯的明拮抗老年患者米库氯铵肌松残余的临床效果 |
| Effect of antagonism of neostigmine on residual neuromuscular blockade from mivacurium chloride in the elderly patients |
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| DOI： |
| 中文关键词: 新斯的明 米库氯铵 老年患者 |
| 英文关键词: Neostigmine Mivacurium Elderly patients |
| 基金项目:陕西省医学会麻醉临床科研重点项目(SXKM2014A07) |
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| 中文摘要: |
| 目的 观察新斯的明对老年患者应用米库氯铵术后肌松残余的影响。方法 选择择期行全麻下腹腔镜下胃肠肿瘤切除手术的老年患者46例,男32例,女14例,年龄65～73岁,体重45～80 kg,ASA Ⅰ或Ⅱ级。将患者随机分为两组,研究组(A组,n=22)术后给予拮抗药新斯的明20 μg／kg,对照组(B组,n=24)给予等量生理盐水。采用四个成串刺激尺神经,通过拇内收肌的收缩反应以监测并记录术毕时(T1)、拔管时(T2)、拔管后5 min(T3)、10 min(T4)、30 min(T5)时的 TOFR(T4／T1, T1 和T4<为第1和第4个颤搐反应高度)。统计拔管时Steward苏醒评分、Ramsay镇静评分及术后不良反应,并记录两组肌松恢复指标:临床时效(M1)(T1恢复到25％的时间)、恢复指数(M2)(T1从25％恢复到75％的时间)、TOFR恢复到0.7的时间(M3)、TOFR从0.7恢复到0.9的时间(M4)、停药至拔管时间(M5)。两组在麻醉诱导前和拔管时分别采集动脉血并检测血浆假性胆碱酯酶活性(D1和D2)。结果 两组患者性别、年龄、身高、体重、BMI、手术时间、失血量、术毕体温、输液量、D1和D2、苏醒评分和镇静评分差异均无统计学意义。两组患者D1和D2的差值D与手术时间、输液量、失血量的相关性分析中,D与输液量明显相关(P<0.05)。A组M1、M2、M3、M4 和M5均明显小于B组(P<0.05)。T3～T5时A组TOFR明显高于B组(P<0.05)。T3、T4时A组TOFR<0.7和T4、T5时A组TOFR<0.9的发生率均低于B组(P<0.05)。结论 米库氯铵肌松恢复快,残余肌松相对较少,使用小剂量新斯的明拮抗使老年患者的麻醉恢复更加安全高效。 |
| 英文摘要: |
| Objective To investigate the effect of Neostigmine on Mivacurium Chloride in postoperative recovery of elderly patients with anesthesia. Methods A total of 46 patients (32 males, 14 females, aged 60-73 years, ASA grade Ⅰ or Ⅱ) who underwent laparoscopic surgery for gastrointestinal tumor under general anesthesia, were randomly divided into two groups. Patients in the studying group (group A, n=22) were given a dosage of eostigmine 20 ug／kg after the end of surgery, and patients in control group (group B, n=24) were given 0.9％ saline solution. Monitored the contract reaction of adductor pollicis through train-of-four ratio (TOFR) by stimulating ulnar nerve. Record condition of recovery from neuromuscular blocked, untoward effect after operation, the activity of the plasmacholinesterase at the time of induction of anaesthesia and extubation. Results The sex, age, height, weight, BMI, operation time, fluid volume, temperature, the activity of the plasmacholinesterase, recovery score and sedation score had no significant difference. Activity decline of the plasmacholinesterase is obviously related with infusion liquid volume, was statistically significant(P<0.05), group A is lower than group B obviously at the recovery of TOFR to 25％, to 70％, 70％ to 90％, onset time and recovery index time, was statistically significant (P<0.05), the difference of TOFR of the two groups was statistically significant at the time of 5 min、10 min、30 min after extubation (P<0.05). The difference of the incidence of TOFR＜0.7 of the two groups at the time of 5 min, 10 min, 30 min after extubation and the difference of the incidence of TOFR＜0.9 of the two groups at the time of 10 min, 30 min after extubation were statistically significant (P<0.05). Conclusion There is obvious significance for neostigmine to resume muscle force in mivacurium chloride postoperative recovery in the elderly. |
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