腹腔镜腹部手术苯磺顺阿曲库铵持续输注的麻醉效果和安全性

doi:10.16139/j.1007-9610.2021.03.014

摘要/Abstract

摘要：

目的：探究苯磺顺阿曲库铵（以下简称顺阿曲库铵）持续输注在腹腔镜腹部手术麻醉中的有效性和安全性。方法：选取2019年1月至2020年1月于瑞金医院古北分院择期行腹腔镜腹部手术病人90例,随机分为持续输注组、间断输注组,每组45例。对两组顺阿曲库铵用药量、起效时间、肌肉松弛不足发生次数、拔除气管导管时间、恢复指数[四个成串刺激（train of four stimulation, TOF）T1从25%恢复至75%的时间]、TOF 70%（停药到TOF恢复为70%的时间）、TOF 90%（停药到TOF恢复为90%的时间）,以及麻醉期、诱导期平均动脉压、心率和不良反应发生情况进行比较。结果：两组顺阿曲库铵起效时间差异无统计学意义（P=0.102）。持续输注组肌肉松弛不足发生次数和顺阿曲库铵用药量显著低于间断输注组（P=0.003,P<0.001）。两组拔管时间差异无统计学意义（P=0.095）。持续输注组病人恢复指数、TOF 70%、TOF 90%均显著低于间断输注组（P均<0.001）。两组麻醉期和诱导期平均动脉压及心率以及不良反应发生率差异均无统计学意义（P>0.05）。结论：腹腔镜腹部手术病人持续输注顺阿曲库铵较间断输注获得更好的肌肉松弛效果,减少用药量,缩短恢复指数,不良反应减少。

关键词: 顺阿曲库铵, 持续输注, 腹腔镜腹部手术

Abstract:

Objective To explore the effects and safety of continuous infusion of cisatracurium in laparoscopic abdominal surgery. Methods Ninety patients undergoing elective laparoscopic abdominal surgery in Gubei Branch of Ruijin Hospital from January 2019 to January 2020 were randomly divided into continuous infusion group (n=45) and intermittent infusion group (n=45). Parameters including dosage of cisatracurium, onset time, lack of muscle relaxant occurrences, extubation time, recovery index, which was stimulation with train of four(TOF) and T1 recovery from 25% to 75%, TOF 70% (recovery time for 70% from drug withdrawal to TOF), TOF 90%(recovery time for 90% from drug withdrawal to TOF), both mean arterial pressure and heart rate during anesthesia and during induction, and adverse reactions were compared between two groups. Results There was no significant difference in onset time of cisatracurium between two groups(P=0.102). Lack of muscle relaxant occurrences(P=0.003) and dosage of cisatracurium (P<0.001) in continuous infusion group was significantly lower than those in intermittent infusion group. There was no significant difference in extubation time between two groups (P=0.095). Recovery index, TOF 70% and TOF 90% in continuous infusion group were significantly lower than those in intermittent infusion group (P<0.001). There was no significant difference in both mean arterial pressure and heart rate during anesthesia and during induction(P>0.05) and in the incidence of adverse reactions(P>0.05) between two groups. Conclusions Compared with intermittent infusion, continuous infusion of cisatracurium in laparoscopic abdominal surgery could have more effect of muscle relaxation, reduce the dosage of cisatracurium, shorten recovery index and reduce adverse reactions.

Key words: Cisatracurium, Continuous infusion, Laparoscopic abdominal surgery

中图分类号:

R614.2

朱倩林, 黎凯, 訾瑜强, 金卫芳. 腹腔镜腹部手术苯磺顺阿曲库铵持续输注的麻醉效果和安全性[J]. 外科理论与实践, 2021, 26(03): 244-248.

ZHU Qianlin, LI Kai, ZI Yuqiang, JIN Weifang. Effects and safety of continuous infusion of cisatracurium in laparoscopic abdominal surgery[J]. Journal of Surgery Concepts & Practice, 2021, 26(03): 244-248.

图/表 5

表1

表2

表3

表4

表5

参考文献 22

[1]	Tulgar S, Boga I, Cakiroglu B, et al. Short-lasting pedia-tric laparoscopic surgery: are muscle relaxants necessary? endotracheal intubation vs. laryngeal mask airway[J]. J Pediatr Surg, 2017, 52(11):1705-1710. doi: 10.1016/j.jpedsurg.2017.02.010 URL
[2]	Kajiura A, Nagata O, Takizawa Y, et al. A large indivi-dual variation in both the infusion rate and the blood concentration of rocuronium necessary for obtain adequate surgical muscle relaxation during total intravenous anesthesia with propofol and remifentanil[J]. J Anesth, 2015, 29(1):9-14. doi: 10.1007/s00540-014-1879-6 pmid: 24997090
[3]	Liu G, Wang R, Yan Y, et al. The efficacy and safety of sugammadex for reversing postoperative residual neuromuscular blockade in pediatric patients: a systematic review[J]. Sci Rep, 2017, 7(1):5724. doi: 10.1038/s41598-017-06159-2 URL
[4]	Chen IY, Liang YY, Chen KS, et al. Comparison of the neuromuscular blocking effects of cisatracurium during isoflurane or propofol anesthesia in dogs[J]. Vet Anaesth Analg, 2020, 47(4):454-462. doi: S1467-2987(20)30049-0 pmid: 32409258
[5]	Huang X, Chen L, Cai Y, et al. Abnormal cisatracurium pharmacodynamics and pharmacokinetics among patients with severe aortic regurgitation during anesthetic induction[J]. BMC Anesthesiol, 2020, 20(1):21. doi: 10.1186/s12871-020-0935-z URL
[6]	Zhou SY, Wang D, Liu C, et al. Laparoscopic gynecological surgery in an adult woman with Becker muscular dystrophy performed with sevoflurane with cisatracurium anesthesia: a case report[J]. Medicine(Baltimore), 2020, 99: e19733.
[7]	Li S, Hu X, Tan F, et al. Effects of cisatracurium, rocuronium, and mivacurium on intraocular pressure during induction of general anesthesia in ophthalmic surgery[J]. Drug Des Devel Ther, 2020, 14:1203-1208. doi: 10.2147/DDDT.S224544 URL
[8]	Rahimzadeh P, Mahmoudi K, Khodaverdi M, et al. Effects of ultrasound guided ganglion stellate blockade on intraoperative and postoperative hemodynamic responses in laparoscopic gynecologic surgery[J]. Wideochir Inne Tech Maloinwazyjne, 2020, 15(2):351-357.
[9]	郭淼森, 李强, 曾维安. 竖脊肌平面阻滞镇痛与硬膜外阻滞镇痛对胸腔镜术后患者恢复质量及疼痛状况的影响[J]. 实用医学杂志, 2020, 36(6):774-778.
[10]	Caron J, Kaye R, Wessel T, et al. An assessment of the centrally acting muscle relaxant tolperisone on driving ability and cognitive effects compared to placebo and cyclobenzaprine[J]. J Clin Pharm Ther, 2020, 45(4):774-782. doi: 10.1111/jcpt.13165 pmid: 32390248
[11]	Shen T, Wang Q, Liu CJ, et al. Euphorbia milii extract-mediated zinc oxide nanoparticles and their antinociceptive, muscle relaxant, and sedative activities for pain management in pediatric children[J]. Appl Nanosci, 2020, 10(4):1297-1303. doi: 10.1007/s13204-019-01210-2 URL
[12]	Byun SH, Kim SJ, Kim E. Comparison of the clinical performance of the flexible laryngeal mask airway in pediatric patients under general anesthesia with or without a muscle relaxant: study protocol for a randomized controlled trial[J]. Trials, 2019, 20(1):31. doi: 10.1186/s13063-018-3141-2 URL
[13]	Younes M, Mahareak A, Badr O. The use of minidose muscle relaxant to facilitate insertion of a laryngeal mask airway[J]. Sci J Al-Azhar Med Fac Girls, 2019, 3(1):220. doi: 10.4103/sjamf.sjamf_9_19 URL
[14]	Thomsen JLD, Mathiesen O, Hägi-Pedersen D, et al. Improving neuromuscular monitoring and reducing residual neuromuscular blockade with E-learning: protocol for the multicenter interrupted time series INVERT study[J]. JMIR Res Protoc, 2017, 6(10):e192. doi: 10.2196/resprot.7527 URL
[15]	Vested M, Tarpgaard M, Eriksen K, et al. Incidence of residual neuromuscular blockade in children below 3 years after a single bolus of cisatracurium 0.1 mg/kg: a quality assurance study[J]. Acta Anaesthesiol Scand, 2020, 64(2):168-172. doi: 10.1111/aas.13495 URL
[16]	邵刚. 不同给药方式对老年脊柱手术患者顺式阿曲库铵用量及肌松恢复的影响[D]. 南京,东南大学, 2016.
[17]	VanderWeide LA, Abdel-Rasoul M, Gerlach AT. The Incidence of hypotension with continuous infusion atracu-rium compared to cisatracurium in the Intensive Care Unit[J]. Int J Crit Illn Inj Sci, 2017, 7(2):113-118. doi: 10.4103/IJCIIS.IJCIIS_35_16 pmid: 28660165
[18]	Dong YJ, Li X. Comparative study on the pharmacodynamics of cisatracurium: continuous infusion or intermittent bolus injection[J]. Contemp Clin Trials, 2012, 33(3):482-485. doi: 10.1016/j.cct.2012.01.002 URL
[19]	李机, 张庆国, 刘中杰, 等. 腹腔镜手术中持续输注与间断静注顺式阿曲库铵维持深度肌松的药效学比较[J]. 临床麻醉学杂志, 2016, 32(4):321-324.
[20]	冉国, 李潺, 祝义军, 等. 行腹腔镜下胃肠肿瘤手术的老年患者间断与持续静脉注射顺阿曲库铵的药效学比较[J]. 上海医学, 2015, 38(6):500-502.
[21]	胡凯, 李亚峰, 程平平. 闭环靶控输注顺式阿曲库铵在骨科手术麻醉中的应用效果[J]. 中国地方病防治杂志, 2016, 31(11):1306.
[22]	张立贤, 曹阳, 李德维, 等. 顺式阿曲库铵应用于大面积烧伤患者时剂量与肌松效应的关系[J]. 实用医学杂志, 2015, 31(11):1845-1848.

项目	持续输注组（n=45）	间断输注组（n=45）	t/χ²值	P值
性别男	27	26	χ²=3.568	0.054
女	18	19
平均年龄（岁）	51.47±8.37	41.46±8.38	t=1.252	0.092
BMI（kg/m²）	22.84±2.36	22.34±2.64	t=0.874	0.312
ASA分级 Ⅱ级	30	29	χ²=1.953	0.076
Ⅲ级	15	16

项目	持续输注组（n=45）	间断输注组（n=45）	t/ χ²值	P值
手术时间（min）	158.67±39.12	172.83±43.51	t=1.6234	0.946
顺阿曲库铵用药量（mg）	37.32±4.63	45.15±5.14	t=14.824	<0.001
起效时间（min）	3.39±0.56	3.51±0.58	t=1.234	0.102
肌肉松弛不足发生次数	5（2~6）	8（4~9）	χ²=5.385	0.003

项目	持续输注组（n=45）	间断输注组（n=45）	t值	P值
拔管时间（min）	54.81±11.61	54.68±11.63	1.325	0.095
恢复指数（min）	14.56±2.14	19.35±2.61	10.314	<0.001
TOF70%（min）	47.23±10.82	52.31±8.53	11.237	<0.001
TOF90%（min）	28.31±3.56	35.24±3.76	10.328	<0.001

项目	持续输注组（n=45）	间断输注组（n=45）	t值	P值
平均动脉压（mmHg）麻醉期	92.16±4.72	92.15±4.81	1.021	0.314
诱导期	78.92±4.15^a)	78.89±4.18^a)	1.231	0.205
心率（次/min）麻醉期	78.95±11.02	79.05±10.96	0.952	0.462
诱导期	78.63±10.95	78.86±11.01	0.854	0.521

项目	持续输注组（n=45）	间断输注组（n=45）	χ²值	P值
面色潮红	1	0	-	-
睁眼困难	1	1	-	-
拔管后乏力	0	1	-	-
总发生率（%）	2（4.44）	2（4.44）	1.125	0.214