【摘要】 目的:观察持续输注米库氯铵在老年患者麻醉恢复期的肌松残余作用,探讨其与血浆假性胆碱酯酶活性的相关性。方法:选择拟行择期腹腔镜下胃肠肿瘤切除手术的老年患者48例,ASAI-II级,随机分成持续输注米库氯铵组(M组)和持续输注顺苯磺酸阿曲库铵组(C组),每组24例。采用4个成串刺激尺神经,通过拇内收肌的收缩反应以监测TOFR值(T4/T1)。记录两组患者围拔管期血流动力学变化、脑电双频指数(BIS)、神经肌肉功能的恢复及术后不良反应等。M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:两组患者年龄、身高、体重、BMI、手术时间、失血量、术毕体温、输液量以及D1和D2的比较,差异无统计学意义(P>0.05)。两组D1与D2的差值D与输液量明显相关,具有统计学意义(r=0.425,P<0.05);M组的临床时效、恢复指数、TOFR恢复到0.7的时间、TOFR从0.7恢复到0.9的时间和停药至拔管时间均明显小于C组(P<0.05);血浆假性胆碱酯酶活性(D1和D2)分别与临床指数、恢复指数、TOFR恢复到0.7的时间、TOFR从0.7恢复到0.9的时间、停药至拔管时间相关性不大(P>0.05),M组肌松残余发生率相对低(P<0.05)。结论:在老年患者全身麻醉手术的围拔管期,米库氯铵的肌松恢复时间短于顺式阿曲库铵,肌松残余作用相对较少,并与血浆假性胆碱酯酶活性有相关性。更多还原

【Abstract】 Objective: To observe the advantage of recovery of neuromuscular blockade of Mivacurium continuous venous infusion in the aged patients undergoing general anesthesia during extubation and investigate the relationship between the recovery and the plasma cholinesterase. Methods: 48 female patients scheduled for gastroenteric tumor resection under laparoscopic surgery were randomized into two groups(n=24 each group). The patients in group C were given Cisatracurium Besilate continuous infusion and the patients in group M were administered with Mivacurium continuous infusion. The contract reaction of adductor pollicis was monitored through train-of-four ratio(TOFR) by stimulating ulnar nerve. The MAP, HR, BIS, condition of recovery from neuromuscular blockade,untoward effect after operation, the activity of the plasma cholinesterase was recorded at the time of induction of anaesthesia and extubation. Results: There was no difference in the age, height, weight, operation time, hemorrhage, temperature, fluid infusion volume.Group M was lower than group C obviously at the recovery of TOFR to 25%, recovery index time, to 70%, 70% to 90%, the time from stopping infusion to extubation. To a certain extent, the activity of the plasma cholinesterase(D1 and D2)appeared to be negatively related to the time of the recovery of TOFR to 25 %, recovery index time, to 70 %, 70 % to 90 % and the time from stopping infusion to extubation, but it was not statistically significant(P>0.05). The incidence of postoperative residual curarization was lower in group M(P<0.05). Conclusions: In the aged patients undergoing general anesthesia during extubation, the recovery from neuromuscular blockade by continuous infusing Mivacurium is fast and the postoperative residual curarization is less, which is related to the activity of the plasma cholinesterase.更多还原