国际麻醉学与复苏杂志   2018, Issue (2): 9-9
    
麻醉后监测治疗室中应用肌松监测仪必要性的临床观察
王馥婧, 李聪, 魏骐, 玄承鸾, 王多友, 麻海春1()
1.吉林大学白求恩第一医院
Clinical observation on the necessity of skeletal muscular relaxation monitoring in post-anesthesia care unit
 全文:
摘要:

目的 探讨PACU中应用肌松监测仪指导麻醉复苏工作的意义。 方法 选取择期行全身麻醉手术术后转入PACU复苏的患者,年龄20~90岁,BMI 16~28 kg/m2,ASA分级Ⅰ~Ⅲ级,术中以顺式阿曲库铵作为肌肉松弛药(肌松药)。入PACU后测量拔管时(T1)、拔管后30 min(T2)和出PACU时(T3)3个时点的四个成串电刺激(train of four stimulation, TOF)比值。比较最后一次应用肌松药到拔管时之间时长≤90 min的患者(≤90 min组)和>90 min的患者(>90 min组)肌松残余(residual neuromuscular blockade, RNMB)的发生率,66~90岁患者(老年患者组)和20~40岁患者(青年患者组)RNMB的发生率。 结果 共262例患者纳入本研究,T1、T2和T3时RNMB发生率分别为76.7%、46.6%、21.0%。≤90 min组患者比>90 min组患者拔管时RNMB发生率高(P<0.01);老年患者组比青年患者组出PACU时RNMB发生率高(P<0.05);出PACU时TOF比值<0.9的患者比≥0.9的患者在PACU平均停留时间长(P>0.05);根据临床指征判断可以出PACU而TOF值<0.9的患者给予肌松拮抗药后,TOF比值恢复到0.9的平均时间为(9±5) min。 结论 根据临床指征决定患者出PACU时RNMB发生率较高,肌松拮抗可以短时间内拮抗RNMB,有必要在PACU中应用肌松监测仪指导患者出PACU。

关键词: 肌松残余; 肌松监测; 顺式阿曲库铵; 麻醉后监测治疗室
Abstract:

Objective To determine if it is necessary to use skeletal muscular relaxation monitoring in the PACU. Methods Two hundred and sixty-two patients, aged 20-90 y, BMI 16-28 kg/m2, of ASAⅠ-Ⅲ, scheduled for surgery under general anesthesia. The cisatracurium was the only neuromuscular blockade agent used during general anesthesia. Monitored the train of four stimulation(TOF) at the time before tracheal extubation (T1), 30 min after tracheal extubation(T2), the time of patients discharged from PACU(T3). The other parameters of patients were also recorded including demographic information, the anesthesia agents and the muscle relaxation antagonism, the length of stay in the PACU and the incidence of hypoxemia. Results The incidence of residual neuromuscular blockad(RNMB) was 76.7%(T1), 46.6%(T2), 21.0%(T3) respectively, the incidence of RNMB between time elapsed from the last administration of cisatracurium to tracheal extubation≤90 min was more than>90 min (P<0.01). The incidence of RNMB in the younger group (20-40 y) was lower than the elderly group (66-90 y)(P<0.05), The length stay in PACU of the patients with TOF ratios<0.9 was longer than the patients with TOF ratios≥0.9 when discharged from PACU(P<0.05). The mean time from using muscle relaxation antagonism to TOF ratio reach 0.9 was(9±5) min. Conclusions The incidence of RNMB was very common in the PACU. It is necessary to monitor the neuromuscular blockade using skeletal relaxation monitoring before the determination of the extubation and the patients transferred to general surgical floor. The antagonism of neuromuscular blockade agent is a safe measure to reduce the incidence of RNMB.

Key words: Residual neuromuscular blockade; Neuromuscular monitoring; Cisatracurium; Post?蛳anesthesia care unit