【摘要】 目的观察拇内收肌和足拇短屈肌在单纯全身麻醉(GA)以及GA联合硬脊膜外腔阻滞(cGEA)下的恢复情况,并探讨硬脊膜外腔阻滞对肌松作用的可能机制。方法选择行腹式全子宫切除术的美国麻醉医师学会(ASA)分级为Ⅰ～Ⅱ级的患者40例,随机分为GA组和cGEA组。cGEA组选取L1～L2间隙行硬膜外穿刺,插管完成后10min开始追加局部麻醉药(0.75%布比卡因2.5mL与2%利多卡因2.5mL的混合液)。予常规麻醉诱导,单次肌颤搐高度稳定在100%左右时,静脉注射维库溴铵0.1mg/kg并完成气管插管。连续刺激尺神经和胫后神经,监测4个成串刺激(TOF)及单刺激肌颤搐(T1/Tc)。分别记录起效时间,TOF中第1、2、3、4个肌颤搐(T1、T2、T3、T4)出现的时间,以及TOF中第4个肌颤搐与第1个肌颤搐的比值(TOFR)恢复至0.25及0.9的时间。当TOFR恢复至0.9时拔管。术后于麻醉后监护室内评价患者的Bromage运动阻滞评分。结果两组间手指、脚趾于首次及末次追加后起效时间的差异均有统计学意义(P值均<0.01)。首次剂量给药后,GA组拇内收肌、拇短屈肌T1、T2、T4出现的时间和临床时效(TOFR恢复至0.25)与同部位的cGEA组的差异均无统计学意义(P值均>0.05)。首次追加后,cGEA组拇内收肌T2、T3、T4出现的时间及临床时效均显著长于GA组(P值分别<0.05、0.01)。末次追加后,cGEA组拇内收肌T1、T2、T3、T4出现的时间、临床时效以及TOFR恢复至0.9的时间均显著长于GA组(P值均<0.05),而两组间足拇短屈肌上述指标的差异均无统计学意义(P值均>0.05)。结论硬脊膜外腔阻滞会加速维库溴铵的起效,减慢恢复,但不能改变拇内收肌和足拇短屈肌肌松的对应关系。更多还原

【Abstract】 Objective To study the effect of epidural block on vecuronium-induced neuromuscular block by observing the time-course of the recovery of thumb and toe under pure general anesthesia(GA)or combined general and epidural anesthesia(cGEA).Methods Forty patients of American Society of Anesthesiologists(ASA)Ⅰ-Ⅱ,who were scheduled for abdominal total hysterectomy,were assigned to Group GA and Group American Society of Anesthesio logiscs(cGEA).Patients in Group cGEA underwent epidural puncture at L1-L2;and 10 min after intubation,local anesthetics were administered.General anesthesia was induced routinely.After calibration and single twitch stimulation height(T1/Tc)was stabilized at 100%,0.1 mg/kg vecuronium was administered to facilitate tracheal intubation.Ulnar nerve and tibial nerve were stimulated separately;train-of-four ratio(TOFR)and T1/Tc were measured with the train-of-four(TOF)-Watch SX acceleromyograph simultaneously.Repeated vecuronium was given when TOFR at the thumb recovered to 0.25.The onset time and the time need to return of T1,T2,T3,T4,and the times of TOFR=0.25,0.90 were recorded.T1/Tc was recorded every 5 min.When patients were transferred to post-anesthesia care unit,Bromage scores were evaluated.Results The onset time of Group GA was significantly longer at the thumb and the toe than that of Group cGEA after first and last repeated administration(P<0.01).There were no significant differences in the time period needed to return of T2,T3,T4 and duration of action(the times of TOFR recovering to 0.25)between the two groups either at the thumb or at the toe.The times to return of T2,T3,T4 and the times of TOFR recovering to 0.25 after first repeated administration were longer at the thumb in Group cGEA than in Group GA(P<0.05,0.01),with no difference found at the toe.After the last administration,the times to return of T1,T2,T3,T4,and the times of TOFR recovering to 0.25 and 0.90 were longer at the thumb in Group cGEA than in Group GA(P<0.05,0.01),with no significant difference found at the toe between the two muscle groups.Conclusions Epidural anesthesia can accelerate the onset of vecuronium,and delay the recovery of its neuromuscular function,but epidural anesthesia cannot change the relationship between the thumb and toe.更多还原