| 潘伶俐,肖珍科,黄嘉瑜,陈 洲,劳俊铭.顺阿曲库铵不同给药方式联合丙泊酚在腹腔镜手术中的应用效果及对肌肉松弛和肌肉松弛恢复的影响[J].,2024,(16):3191-3195 |
| 顺阿曲库铵不同给药方式联合丙泊酚在腹腔镜手术中的应用效果及对肌肉松弛和肌肉松弛恢复的影响 |
| The Application Effect of Different Administration Methods of Shunatracurium combined with Propofol in Laparoscopic Surgery and Its Impact on Muscle Relaxation and Recovery |
| 投稿时间：2024-01-05 修订日期：2024-01-31 |
| DOI：10.13241/j.cnki.pmb.2024.16.038 |
| 中文关键词: 顺阿曲库铵 给药方式 腹腔镜手术 肌肉松弛 |
| 英文关键词: Shunatracurium Administration method Laparoscopic surgery Muscle relaxation |
| 基金项目:国家自然科学基金项目（81774348） |
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| 中文摘要: |
| 摘要 目的：探讨顺阿曲库铵不同给药方式联合丙泊酚在腹腔镜手术中的应用效果及对肌肉松弛和肌肉松弛恢复的影响。方法：选取我院2021年1月到2023年11月收治的120例腹腔镜手术患者，分为间断性给药组与一次性给药组，各组均为60例。所有患者进入手术室后采取2 mg/kg丙泊酚、0.4 μg/kg舒芬太尼、0.5 μg/kg右美托咪定进行麻醉诱导。间断性给药组每隔2 h静脉注射顺阿曲库铵一次，剂量为0.1 mg/kg。一次性给药组采取单次0.1 mg/kg静脉注射顺阿曲库铵进行诱导肌松，并依照T1颤搐抑制值判断肌松效应，T1=12%，当T1＞12%时静脉注射顺阿曲库0.03 mg/kg。对比两组患者顺阿曲库铵用药量、肌松有效时间、肌松维持时间、T1最大抑制、肌松起效时间，入室时的基础值（T1），手术开始即刻（T2），手术开始后20 min（T3），手术结束即刻（T4）生命体征变化，术后肌肉松弛恢复情况以及不良反应发生率。结果：两组患者肌松维持时间、Ｔ1最大抑制程序、肌松起效时间对比无明显差异（P＞0.05），一次性给药组患者顺阿曲库铵用药量低于间断性给药组，肌松有效时间高于间断性给药组（P＜0.05）；两组患者T1、T2、T3、T4时间心率（HR）、收缩压（SBP）、血氧饱和度（SPO2）、舒张压（DBP）水平并无明显变化，且一次性给药组与间断性给药组相比无明显差异（P＞0.05）；一次性给药组患者TOFr 0.90、TOFr 0.80、TOFr 0.75、TOFr 0.25及拔管时间明显低于间断性给药组（P＜0.05）；一次性给药组心动过缓、皮疹、支气管痉挛、低血压等不良反应发生率明显低于间断性给药组（P＜0.05）。结论：在腹腔镜手术中采取间断性给药组及一次性给药顺阿曲库铵对患者术中生命体征、肌松维持时间及肌松效果并无明显影响，但采取一次性给药，并以T1颤搐抑制值判断肌松效应进行给药可减少顺阿曲库铵给药剂量，促进术后肌肉松弛恢复，且安全性高。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the application effect of different administration methods of cisatracurium combined with propofol in laparoscopic surgery and its impact on muscle relaxation and recovery. Methods: 120 patients who underwent laparoscopic surgery in our hospital from January 2021 to November 2023 were selected. They were randomly divided into an intermittent medication group and a one-time medication group, with 60 patients in each group. All patients were treated with 2 mg/kg propofol, 0.4 μg/kg sufentanil, and 0.5 μg/kg after entering the operating room. The intermittent administration group received intravenous injection of cisatracurium once every 2 hours, with a dose of 0.1 mg/kg. The one-time administration group received a single intravenous injection of 0.1 mg/kg cisatracurium to induce muscle relaxation, and the muscle relaxation effect was determined based on the T1 seizure inhibition value, with T1=12%. When T1>12%, intravenous injection of 0.03 mg/kg cisatracurium was administered. Compare the dosage, effective time of muscle relaxation, maintenance time of muscle relaxation, maximum inhibition of T1, onset time of muscle relaxation, baseline value upon entry (T1), immediate start of surgery (T2), 20 minutes after surgery (T3), and immediate end of surgery (T4) in two groups of patients, as well as the changes in vital signs, recovery of postoperative muscle relaxation, and incidence of adverse reactions. Results: There was no significant difference in the maintenance time, T1 maximum inhibition program, and onset time of muscle relaxation between the two groups of patients (P>0.05). The dosage of cisatracurium in the one-time treatment group was lower than that in the intermittent treatment group, and the effective time of muscle relaxation was higher than that in the intermittent treatment group (P<0.05); There were no significant changes in heart rate (HR), systolic blood pressure (SBP), blood oxygen saturation (SPO2), and diastolic blood pressure(DBP) levels at T1, T2, T3, and T4 in the two groups of patients, and there was no significant difference between the one-time administration group and the intermittent administration group (P>0.05); The TOFr 0.90, TOFr 0.80, TOFr 0.75, TOFr 0.25, and extubation time of patients in the one-time administration group were significantly lower than those in the intermittent administration group(P<0.05); The incidence of adverse reactions such as bradycardia, rash, bronchospasm, and hypotension in the one-time administration group was significantly lower than that in the intermittent administration group(P<0.05). Conclusion: Intermittent administration and one-time administration of cisatracurium in laparoscopic surgery have no significant impact on the patient's intraoperative vital signs, muscle relaxation maintenance time, and muscle relaxation effect. However, one-time administration and T1 seizure inhibition value can reduce the dosage of cisatracurium administration, promote postoperative muscle relaxation recovery, and have high safety. |
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