王小华,
张宗泽^,
武汉大学中南医院 麻醉科, 湖北 武汉 430071

详细信息 作者简介: 王小华(1991-), 男, 住院医师。E-mail:692005504@qq.com


通讯作者: 张宗泽, 教授。E-mail:zhangzz@whu.edu.cn 中图分类号: R614


摘要:目的观察顺苯磺酸阿曲库铵不同给药方式对胸科手术麻醉管理的影响。方法选取全麻下择期行开胸手术的患者60例，ASAⅠ~Ⅱ级，随机分为两组（n=30），A组术中顺苯磺酸阿曲库铵采用单次静推的方法，B组术中采用持续泵入的方法，记录并比较两组患者手术时间、停药至拔管时间、停药至出手术室时间、停药后4个成串刺激比率（train-of-four ratio，TOFr）从25%恢复至75%的时间、TOFr从25%恢复至90%的时间、TOFr=75%和TOFr=90%时的拔管率；单肺通气前后不同时间的肺顺应性、气道压；手术过程的总用药量。结果A、B两组患者手术时间、TOFr从25%恢复至75%的时间、从25%恢复至90%的时间、术中总用药量、拔管率比较差异均无统计学意义（P>0.05）；B组患者停药至拔管时间（43±15.2）min、停药至离室时间（60±14.3）min，均低于A组的（55±17.5）min和（75±27.6）min；B组患者单肺通气后0.5 h和1 h肺部的顺应性为（23.1±1.9）mL/cmH₂O、（22.9±2.2）mL/cmH₂O，均高于A组的（20.8±2.6）mL/cmH₂O和（21.1±2.0）mL/cmH₂O；B组单肺通气后0.5 h和1 h的气道峰压（24.2±1.6）cmH₂O、（24.1±1.2）cmH₂O，均低于A组的（26.2±1.7）cmH₂O和（25.7±1.8）cmH₂O，差异均有统计学意义（P < 0.05）。结论胸科手术中持续泵入顺苯磺酸阿曲库铵可以较好地改善单肺通气后肺部顺应性及气道压。
关键词: 顺苯磺酸阿曲库铵/
胸科手术/
持续泵入/
肺顺应性/
气道压/
拔管时间


Abstract:ObjectiveTo study the effects of different administration methods of cisatracurium on anesthesia management in thoracic surgery.MethodsTotally, 60 ASAⅠ-Ⅱ patients with thoracotomy were randomly divided into 2 groups (n=30), group A treated with single Ⅳ bolus dose of cisatracurium and group B with continuous Ⅳ pump during the surgery. The operation time, the time from drug withdrawal to extubation or exit of the operation room, the recovery time of TOFr from 25% to 70% and 90%, the extubating rates at the time of TOFr=70% and TOFr=90%, the lung compliance and airway pressure changes after single lung ventilation, and the total intraoperative drug dosage were compared between the two groups of patients.ResultsThere were no significant differences in the time of operation, TOFr recovery time from 25% to 75%, from 25% to 90%, the total intraoperative drug dosage and the rates of extubation between group A and group B (P>0.05). The time from drug withdrawal to extubation (43±15.2) min and exit of the operation room (60±14.3) min in group B were lower than those in group A (55±17.5) min and (75±27.6) min, respectively. The lung compliance in group B at 0.5h (23.1±1.9) mL/cmH₂O and 1 hour (22.9±2.2) mL/cmH₂O after single lung ventilation were higher than those in group A (20.8±2.6) mL/cmH₂O and (21.1±2.0) mL/cmH₂O, respectively. The peak airway pressure in group B at 0.5h (24.2±1.6) cmH₂O and 1 hour (24.1±1.2) cmH₂O after single lung ventilation were lower than those in group A (26.2±1.7) cmH₂O and (25.7±1.8) cmH₂O, respectively (P < 0.05).ConclusionsContinuous Ⅳ pump of cisatracurium during thoracic surgery can improve the lung compliance and airway pressure after single lung ventilation.
Keywords:cisatracurium/
thoracic surgery/
continuous infusion/
lung compliance/
airway pressure/
extubation time

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