顺式阿曲库铵联合丙泊酚对全身麻醉手术患者应激反应和围拔管期残余肌松效应的影响

发布时间：2018-12-16 17:27

【摘要】：目的探讨顺式阿曲库铵联合丙泊酚对全身麻醉手术患者应激反应和围拔管期残余肌松效应的影响。方法选取2009年1月至2013年4月本院确诊治疗的全身麻醉手术患者86例,依据随机分配原则分为联合麻醉组(n=57)和常规麻醉组(n=31),两组患者均给予丙泊酚4.0~8.0mg/kg,间断泵注瑞芬太尼2.0μg/kg麻醉治疗,联合麻醉组患者在此基础上给予静脉推注0.5mg/kg顺式阿曲库铵麻醉治疗。其中联合麻醉组根据丙泊酚使用剂量分为小剂量组(4.0 mg/kg)、中剂量组(6.0mg/kg)、大剂量组(8.0mg/kg)。应用Cooper评分法对所有患者插管条件进行评估,统计分析所有患者插管条件优良情况、麻醉前、麻醉时、插管时、切皮时、拔管时平均动脉压(MAP)、心率(HR)和围拔管期肌松恢复指数、起效时间、作用时间。结果联合麻醉组患者插管条件优良率明显高于常规麻醉组,差异有统计学意义(P0.05);麻醉前、麻醉时,所有患者MAP、HR水平差异无统计学意义(P0.05);麻醉后,联合麻醉组患者各时点MAP、HR水平明显低于常规麻醉组,差异有统计学意义(P0.05);在麻醉后各时点MAP、HR水平,中剂量组低于小剂量组,而小剂量组又低于大剂量组,差异有统计学意义(P0.05);联合麻醉组患者肌松恢复指数、起效时间、作用时间明显高于常规麻醉组,差异有统计学意义(P0.05)。结论顺式阿曲库铵联合丙泊酚可有效改善全身麻醉手术患者插管条件,降低手术过程中机体的应激反应,配合使用中剂量丙泊酚麻醉可产生更为良好的稳定应激反应,具有良好的肌松效应,值得临床进一步推广。
[Abstract]:Objective to investigate the effects of cis-atracurium combined with propofol on stress response and extubation residual muscle relaxation in patients undergoing general anesthesia. Methods 86 patients with general anesthesia were selected from January 2009 to April 2013. According to the principle of random distribution, they were divided into two groups: combined anesthesia group (n = 57) and routine anesthesia group (n = 31). The patients in both groups were given propofol 4.0 mg / kg (8.0 mg / kg). Intravenous injection of remifentanil 2.0 渭 g/kg was performed in the combined anesthesia group. The patients in the combined anesthesia group were given 0.5mg/kg cis atracurium anesthesia on the basis of intravenous injection of remifentanil. According to the dosage of propofol, the combined anesthesia group was divided into three groups: low dose group (4.0 mg/kg), middle dose group (6.0mg/kg) and high dose group (8.0mg/kg). The condition of intubation in all patients was evaluated by Cooper scoring method. The mean arterial pressure (MAP),) before anesthesia, during intubation and during extubation was analyzed statistically. Heart rate (HR), recovery index of muscle relaxation during extubation, onset time and action time. Results the excellent and good rate of intubation condition in the combined anesthesia group was significantly higher than that in the routine anesthesia group (P0.05), but there was no significant difference in MAP,HR level between all patients before anesthesia and during anesthesia (P0.05). After anesthesia, the level of MAP,HR in the combined anesthesia group was significantly lower than that in the routine anesthesia group at each time point, the difference was statistically significant (P0.05). At each time point after anesthesia, the level of MAP,HR in middle dose group was lower than that in small dose group, while in small dose group was lower than that in large dose group, the difference was statistically significant (P0.05). The recovery index of muscle relaxation, onset time and action time of combined anesthesia group were significantly higher than those of routine anesthesia group (P0.05). Conclusion cis-atracurium combined with propofol can effectively improve the intubation conditions of patients undergoing general anesthesia and reduce the stress response of the body during the operation. Combined with moderate dose propofol anesthesia can produce a better stable stress response. It has good muscle relaxation effect and is worthy of further clinical promotion.
【作者单位】：山东省东营市胜利油田胜利医院麻醉手术科;
【分类号】：R614

【参考文献】