肌松监测指导老年患者全麻后气管拔管与传统拔管的比较(1)
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2010年1月1日
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【摘要】目的:观察肌松监测下指导老年患者全麻后气管拔管的血液动力学变化及术后肌松残余的发生率。方法:选择老年患者100例,年龄65-75岁,ASAⅠ～Ⅱ级,实施全凭静脉麻醉。随机分为肌松监测下气管拔管组(A组)和传统气管拔管组(B组)各50例。记录各时间点(术前、拔管时、拔管后30min、拔管后1h)的MAP,HR,脑电双频指数(BIS),四个成串刺激(TOF),TOF<0.9为肌松残余。结果:肌松监测组MAP,HR指标稳定(P>0.05),拔管后1h的肌松残余(PORC)发生率为0%;传统组MAP,HR均有显著变化(P<0.01),拔管后1h的PORC发生率28%。结论:老年患者在肌松监测下气管拔管,其血流动力学稳定,术后肌松残余发生率低,具有临床应用价值。
【关键词】肌松残余;气管拔管;四个成串刺激;脑电双频指数
【中图分类号】R614.2 【文献标识码】A 【文章编号】1008-6455(2010)07-0107-02
Monitoring of muscle relaxation in elderly patients with Tracheal extubation comparison with traditional
Zhang Lifeng Bao Yang Shi Dongping et al.
【Abstract】Objective:Monitoring of muscle relaxation through the guidance of elderly patients with tracheal extubation, Observe the change after the hemodynamics and the postoperative residual curarizationmuscle(PORC) the rate. Methods:Choice of 100 cases of elderly patients, aged 65-75 years old, ASA grade Ⅰ ~ Ⅱ implement total intravenous anesthesia (tiva).Randomly divided into monitoring of muscle relaxant group (A group) and the traditional group (B group).Record (before surgery, during extubation, after extubation 30min,after extubation 1 hour.) MAP,HR,BIS,TOF.TOF<0.9 defind for PORC. Results monitoring of muscle relaxant group MAP, HR were stable(P>0.05),after extubation 1 hour of PORC incidence of 0%;the traditional group MAP,HR changes were significant(P<0.01),PORC incidence of 28%. Conclusion:Muscle relaxation in elderly patients with tracheal extubation under monitoring,the hemodynamics were stable,PORC of is lower. Have value in clinical.
【Key words】Postoperative residual curarizationmuscle(PORC);Tracheal extubation;Train of four(TOF);Bispeetral index(BIS)
1 资料与方法
1.1 一般资料:选择ASAⅠ-Ⅱ级择期老年全麻患者100例,年龄70±5岁,体重50-75Kg,无严重心、肺、肝、肾功能障碍。100例随机分为肌松监测下气管拔管组(A组)和传统气管拔管组(B组)各50例。
1.2 方法:入手术室后开放外周静脉,监测MAP、HR、BIS,采用HXD-1C028肌松监测仪,以四个成串刺激形式(TOF值)监测肌松。全凭静脉麻醉,诱导:咪唑安定0.05mg/kg、芬太尼3ug/kg、异丙酚1.5mg/kg、顺式阿曲库铵0.15mg/kg。维持:异丙酚5-10mg/kg/h泵注;瑞芬太尼8-10ug/kg/h泵注;维持术中BIS=40-60之间;顺式阿曲库铵追加量为0.1mg/kg,45分钟追加一次。A组术毕持续静注异丙酚使BIS=75±5,在TOF≥0.9时停用并拔除气管导管;B组术毕停药,在临床评估下拔管。两组均不拮抗。
1.3 观察指标:分别记录两组术前、拔管时、拔管后30min、拔管后1h的MAP、HR、BIS、TOF。TOF<0.9为肌松残余(PORC)。
1.4 统计学方法:使用SPSS13.0软件包进行统计学处理,计量资料数据以均数±标准差(x±s)表示,组间比较采用斜方差分析,计数资料采用t检验,P<0.05认为差异有显著性。
2 结果
A组:拔管时、拔管后30min、拔管后1h的MAP、HR较术前无明显差异(P>0 ......
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