摘要
目的探讨七氟烷吸入麻醉和丙泊酚-瑞芬太尼复合维持麻醉对短小手术后肌松残余的影响。方法纳入2020年5月-2021年1月重庆医科大学附属第二医院耳鼻喉科在全麻下行择期手术的患者104例,依据麻醉维持方式不同分为七氟烷组(全麻后使用七氟烷吸入维持麻醉深度)与丙泊酚-瑞芬太尼组(全麻后使用丙泊酚-瑞芬太尼维持麻醉深度)。记录患者拔管时4个成串刺激比值(TOFr)、拔管后发生的呼吸道不良事件。比较不同麻醉药物对患者拔管时肌松残余及拔管后呼吸道不良事件发生率的影响。结果两组年龄、性别、美国麻醉师协会(ASA)分级、体重指数(BMI)、手术时间、给予肌松药至拔管时间、拔管时脑电双频指数(BIS)差异无统计学意义(P>0.05)。七氟烷组与丙泊酚-瑞芬太尼组拔管时肌松残余发生率及拔管后呼吸道不良事件发生率比较,差异无统计学意义[69.4%(34/49)vs.53.8%(28/52),P>0.05;2.0%(1/49)vs.9.6%(5/52),P>0.05]。七氟烷组患者拔管时TOFr低于丙泊酚-瑞芬太尼组,差异有统计学意义[85%(78%,90%)vs.89%(84%,93%),P<0.05]。肌松残余发生率与年龄、BMI、手术时间、给予肌松药至拔管时间、拔管时BIS有关(P<0.05)。结论使用七氟烷维持麻醉并未增高拔管时肌松残余发生率,短小手术全麻拔管时肌松残余发生率较高,推荐有条件时应进行肌松监测以提高安全性。
Objective To investigate the effects of sevoflurane inhalation anesthesia and propofol-remifentanil combined maintenance anesthesia on the incidence of postoperative residual curarisation(PORC)in minor surgery.Methods A total of 104 patients who underwent elective surgery under general anesthesia in the Second Affiliated Hospital of Chongqing Medical University from May 2020 to January 2021 were selected for this study.Patients were divided into Sevo group(maintenance by inspirating sevoflurance)and PR group(maintenance by intravenous injecting propofol and remifentanil).The train-of-four ratio(TOFr)during extubation and the existence of adverse respiratory events after extubation were recorded.The incidence of residual muscle relaxation during extubation and the incidence of adverse respiratory events after extubation were compared under different anesthesia maintenance conditions.Results There were no significant differences in age,gender,American Society of Anesthesiologists(ASA)classification,body mass index(BMI),operation time,time from muscle relaxant administration to extubation,and bispect ralindex(BIS)at extubation between two groups(P>0.05).There was no significant difference in the incidence rate of PORC and adverse respiratory events between Sevo group and PR group[69.4%(34/49)vs.53.8%(28/52),P>0.05;2.0%(1/49)vs.9.6%(5/52),P>0.05].TOFr in Sevo group was slightly lower than that in PR group,and the difference was statistically significant[85%(78%,90%)vs.89%(84%,93%),P<0.05].The overall incidence of PORC was high,which was correlated with age,BMI,operative time,time from muscle relaxant administration to extubation,and BIS at extubation(P<0.05).Conclusion Sevoflurane anesthesia maintenance does not increase the incidence of muscle relaxation residual during extubation.The incidence of PORC can be high during extubation under general anesthesia in minor surgery.Muscle relaxation monitoring should be performed routinely during general anesthesia to improve safety.
作者
周玲
向思霖
杨杰
李晓霞
Zhou Ling;Xiang Si-Lin;Yang Jie;Li Xiao-Xia(Department of Anesthesiology,the Second Affiliated Hospital of Chongqing Medical University,Chongqing 404000,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2021年第9期935-939,共5页
Medical Journal of Chinese People's Liberation Army
关键词
肌松残余
肌松监测
短小手术麻醉管理
七氟烷
residual curarisation
muscle relaxant monitoring
anesthesia management for minor surgery
sevoflurane
