米库氯铵与顺苯磺酸阿曲库铵在耳鼻喉手术中的麻醉效果及血流动力学变化比较
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摘要
目的比较米库氯铵与顺苯磺酸阿曲库铵在耳鼻喉手术中的麻醉效果及血流动力学变化。方法选择2017年1月～2018年1月于保定市第二医院拟行全身麻醉下耳鼻喉手术的患者80例,按照随机数字表法随机分成观察组和对照组,每组各40例。患者入室麻醉诱导并给予肌松药,其中对照组给予顺苯磺酸阿曲库铵,观察组给予米库氯铵。记录患者入室(T_1)、麻醉诱导即刻(T_2)、插管(T_3)、手术结束(T_4)、意识恢复(T_5)、拔管(T_6)、出室(T_7)7个时间点的平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SpO_2)等血流动力学指标及脑电双频指数(BIS)值、4个成串刺激(TOF)值。记录患者恢复自主时间、睁眼时间、拔管时间、躁动及并发症发生情况。结果两组患者T_1～T_7不同时间点MAP、HR、SpO_2值比较,差异均无统计学意义(P> 0.05);与本组T_1、T_2时间点比较,对照组T_5、T_6、T_7及观察组T_7时间点的SpO_2水平明显降低,差异有统计学意义(P <0.05)。与对照组比较,观察组T_4、T_7两个时间点BIS值升高,T_4、T_5、T_6、T_7四个时间点TOF值升高,差异均有统计学意义(P <0.05);两组其他时间点的BIS及TOF值比较,差异均无统计学意义(P> 0.05)。与本组T_1、T_2时间点比较,对照组T_4、T_5、T_6、T_7及观察组T_4、T_5、T_6的TOF值下降,两组T_3、T_4、T_5时间点的BIS降低,差异有统计学意义(P <0.05)。观察组恢复自主时间、睁眼时间、拔管时间均较对照组缩短,拔管后躁动、并发症发生率均低于对照组,差异均有统计学意义(P <0.05)。结论米库氯铵在围术期麻醉中对患者血流动力学的影响较小,起效迅速,诱导时间短,术后肌肉收缩功能恢复快,无神经肌肉阻滞的蓄积作用,术后肌松残余者少,适合耳鼻喉手术,安全有效,值得临床上推广。
Objective To compare the anesthetic effect and hemodynamic changes of Mivacurium Chloride and Cisatracurium Besylate in ear-nose-throat surgery. Methods From January 2017 to January 2018, 80 patients with planed operation of ear, nose and throat under general anesthesia in the Second Hospital of Baoding were divided into observation group and control group according to random number table, 40 cases in each group. Patients were given muscle relaxants for general anesthesia induction, and the control group was given the Cisatracurium Besylate, the observation group was given Mivacurium Chloride. The MAP, HR, SpO_2, BIS and four TOF value at seven time points of the home invasion(T_1), anesthetic induction immediately(T_2), intubation(T_3), end of the surgery(T_4), consciousness recovery(T_5), tube drawing(T_6), leaving the room(T_7) were recorded. T_he time of recover, open eyes, extubation, and the restlessness and complications of patients were recorded. Results T_here were no significant differences in MAP, HR, and SpO_2 between the two groups from T_1 to T_7(P > 0.05). Compared with T_1 and T_2 of the same group, the levels of SpO2 in the control group at T_5, T_6 and the observation group at T_7 decreased, and the differences were statistically significant(P < 0.05).Compared with the control group, the BIS values at T_4, T_7 and the T_OF values at T_4 to T_7 were increased in the observation group, and the differences were statistically significant(P < 0.05); the BIS and T_OF values of other time points between two groups were not statistically significant(P > 0.05). Compared with T_1 and T_2 of the same group, T_OF values of T_4, T_5, T_6, T_7 in the control group and T_4, T_5, T_6 in the observation group decreased, and the BIS of T_3, T_4, T_5 in the two groups decreased and the differences were statistically significant(P < 0.05). T_he time of recovery, open eyes,extubation in observation group were shorter than those in control group, the incidence of extubation after agitation and complications was lower than those in control group,the differences were statistically significant(P < 0.05). Conclusion T_he effects of Mivacurium Chloride on hemodynamics perioperative anesthesia is small, work quickly, short induction time, fast recovery of muscle contraction function,and without the effect of neuromuscular blockade accumulation, it has less postoperative muscle relaxant residual, and is suitable for the ear, nose and throat surgery, safe and effective, which is worth popularizing clinically.
Objective To compare the anesthetic effect and hemodynamic changes of Mivacurium Chloride and Cisatracurium Besylate in ear-nose-throat surgery. Methods From January 2017 to January 2018, 80 patients with planed operation of ear, nose and throat under general anesthesia in the Second Hospital of Baoding were divided into observation group and control group according to random number table, 40 cases in each group. Patients were given muscle relaxants for general anesthesia induction, and the control group was given the Cisatracurium Besylate, the observation group was given Mivacurium Chloride. The MAP, HR, SpO_2, BIS and four TOF value at seven time points of the home invasion(T_1), anesthetic induction immediately(T_2), intubation(T_3), end of the surgery(T_4), consciousness recovery(T_5), tube drawing(T_6), leaving the room(T_7) were recorded. T_he time of recover, open eyes, extubation, and the restlessness and complications of patients were recorded. Results T_here were no significant differences in MAP, HR, and SpO_2 between the two groups from T_1 to T_7(P > 0.05). Compared with T_1 and T_2 of the same group, the levels of SpO2 in the control group at T_5, T_6 and the observation group at T_7 decreased, and the differences were statistically significant(P < 0.05).Compared with the control group, the BIS values at T_4, T_7 and the T_OF values at T_4 to T_7 were increased in the observation group, and the differences were statistically significant(P < 0.05); the BIS and T_OF values of other time points between two groups were not statistically significant(P > 0.05). Compared with T_1 and T_2 of the same group, T_OF values of T_4, T_5, T_6, T_7 in the control group and T_4, T_5, T_6 in the observation group decreased, and the BIS of T_3, T_4, T_5 in the two groups decreased and the differences were statistically significant(P < 0.05). T_he time of recovery, open eyes,extubation in observation group were shorter than those in control group, the incidence of extubation after agitation and complications was lower than those in control group,the differences were statistically significant(P < 0.05). Conclusion T_he effects of Mivacurium Chloride on hemodynamics perioperative anesthesia is small, work quickly, short induction time, fast recovery of muscle contraction function,and without the effect of neuromuscular blockade accumulation, it has less postoperative muscle relaxant residual, and is suitable for the ear, nose and throat surgery, safe and effective, which is worth popularizing clinically.
引文
[1]Kochhar A,Banday J,Ahmad Z,et al.Pregabalin in monitored anesthesia care for ear-nose-throat surgery[J].Anesth Essays Res,2017,11(2):350-353.
[2]Vermi謝sli S,覶ukurova I,Baydur H,et al.Relationship between preoperative patient learning need and anxiety o patients hospitalized at Ear Nose Throat and Head Neck Surgery clinic for surgical treatment[J].Kulak Burun Bogaz Ihtis Derg,2016,26(2):79-91.
[3]段宏伟,吴海星,吴一鸣,等.维库溴铵的麻醉药理学研究进展[J].中国临床研究,2018,31(2):266-269.
[4]胡振华,鲁华,代山等.同步间歇指令通气用于喉罩通气无肌松药全麻下支气管镜检查术患者气道管理的效果[J]中华麻醉学杂志,2015,35(11):1407-1408.
[5]鲁显福,曾因明.米库氯铵的过去、现在与未来[J].国际麻醉学与复苏杂志,2010,31(5):423-426,430.
[6]吕慧,马鹤,朱卓,等.新型非去极化肌松药-米库氯铵[J]中国实验诊断学,2013,17(7):1359-1361.
[7]曾春红.地佐辛对小儿耳鼻喉手术全身麻醉苏醒期躁动的影响[J].中国医药导刊,2015,(10):1045-1046,1049.
[8]柳春玲.两种不同麻醉方式在老年耳鼻喉手术中的麻醉效果比较[J].当代医学,2015,21(35):66-67.
[9]何雨竹,沈丹敏,房永利,等.不同因素对耳鼻喉手术术后疼痛的影响[J].北京医学,2015,37(2):154-156.
[10]赵海琴.全麻手术患者麻醉复苏期的躁动因素分析与护理[J].实用临床医药杂志,2017,21(18):88-90.
[11]杨沁岩,陈钰铨,陈强,等.监护麻醉对局部麻醉手术应激反应的调控效果[J].中国医师进修杂志,2015,38(7):518-521.
[12]王馥婧,李聪,魏骐,等.麻醉后监测治疗室中应用肌松监测仪必要性的临床观察[J].国际麻醉学与复苏杂志,2018,39(2):132-135.
[13]Zeng R,Liu X,Zhang J,et al.The efficacy and safety of mivacurium in pediatric patients[J].BMC Anesthesiol,2017,17,17(1):58.
[14]Wichmann S,F覸rk G,Bundgaard JR,et al.Patients with prolonged effect of succinylcholine or mivacurium had novel mutations in the butyrylcholinesterase gene[J].Pharmacogenet Genomics,2016,26(7):351-356.
[15]Eskildsen KZ,G覿tke MR.Danish Cholinesterase Research Unit diagnoses patients with prolonged paralysis after succinylcholine and mivacurium[J].Ugeskr Laeger,2015,177(18):866-868.
[16]Dimov D,Kanev K,Dimova I.Correlation between butyrylcholinesterase variants and sensitivity to soman toxicity[J].Acta Biochim Pol,2012,59(2):313-316.
[17]Ozdamar D,Dayioglu H,Anik I,et al.Evaluation of the neurotoxicity of intrathecal dexmedetomidine on rat spinal cord(electromicroscopic observations)[J].Saudi JAnaesth,2018,12(1):10-15.
[18]Jiang L,Li H,Zhao N.Thymoquinone protects against cobalt chloride-induced neurotoxicity via Nrf2/GCL-regulated glutathione homeostasis[J].J Biol Regul Homeost Agents,2017,31(4):843-853.
[19]Al-Ajmi AM,Morad MA,Cooper PE,et al.Reversible ethyl chloride Neurotoxicity:a case report[J].Can J Neurol Sci,2018,45(1):119-120.
[20]Abulfadl YS,El-Maraghy NN,Ahmed AAE,et al.Protective effects of thymoquinone on D-galactose and aluminum chloride induced neurotoxicity in rats:biochemical,histological and behavioral changes[J].Neurol Res,2018,40(4):324-333.
[2]Vermi謝sli S,覶ukurova I,Baydur H,et al.Relationship between preoperative patient learning need and anxiety o patients hospitalized at Ear Nose Throat and Head Neck Surgery clinic for surgical treatment[J].Kulak Burun Bogaz Ihtis Derg,2016,26(2):79-91.
[3]段宏伟,吴海星,吴一鸣,等.维库溴铵的麻醉药理学研究进展[J].中国临床研究,2018,31(2):266-269.
[4]胡振华,鲁华,代山等.同步间歇指令通气用于喉罩通气无肌松药全麻下支气管镜检查术患者气道管理的效果[J]中华麻醉学杂志,2015,35(11):1407-1408.
[5]鲁显福,曾因明.米库氯铵的过去、现在与未来[J].国际麻醉学与复苏杂志,2010,31(5):423-426,430.
[6]吕慧,马鹤,朱卓,等.新型非去极化肌松药-米库氯铵[J]中国实验诊断学,2013,17(7):1359-1361.
[7]曾春红.地佐辛对小儿耳鼻喉手术全身麻醉苏醒期躁动的影响[J].中国医药导刊,2015,(10):1045-1046,1049.
[8]柳春玲.两种不同麻醉方式在老年耳鼻喉手术中的麻醉效果比较[J].当代医学,2015,21(35):66-67.
[9]何雨竹,沈丹敏,房永利,等.不同因素对耳鼻喉手术术后疼痛的影响[J].北京医学,2015,37(2):154-156.
[10]赵海琴.全麻手术患者麻醉复苏期的躁动因素分析与护理[J].实用临床医药杂志,2017,21(18):88-90.
[11]杨沁岩,陈钰铨,陈强,等.监护麻醉对局部麻醉手术应激反应的调控效果[J].中国医师进修杂志,2015,38(7):518-521.
[12]王馥婧,李聪,魏骐,等.麻醉后监测治疗室中应用肌松监测仪必要性的临床观察[J].国际麻醉学与复苏杂志,2018,39(2):132-135.
[13]Zeng R,Liu X,Zhang J,et al.The efficacy and safety of mivacurium in pediatric patients[J].BMC Anesthesiol,2017,17,17(1):58.
[14]Wichmann S,F覸rk G,Bundgaard JR,et al.Patients with prolonged effect of succinylcholine or mivacurium had novel mutations in the butyrylcholinesterase gene[J].Pharmacogenet Genomics,2016,26(7):351-356.
[15]Eskildsen KZ,G覿tke MR.Danish Cholinesterase Research Unit diagnoses patients with prolonged paralysis after succinylcholine and mivacurium[J].Ugeskr Laeger,2015,177(18):866-868.
[16]Dimov D,Kanev K,Dimova I.Correlation between butyrylcholinesterase variants and sensitivity to soman toxicity[J].Acta Biochim Pol,2012,59(2):313-316.
[17]Ozdamar D,Dayioglu H,Anik I,et al.Evaluation of the neurotoxicity of intrathecal dexmedetomidine on rat spinal cord(electromicroscopic observations)[J].Saudi JAnaesth,2018,12(1):10-15.
[18]Jiang L,Li H,Zhao N.Thymoquinone protects against cobalt chloride-induced neurotoxicity via Nrf2/GCL-regulated glutathione homeostasis[J].J Biol Regul Homeost Agents,2017,31(4):843-853.
[19]Al-Ajmi AM,Morad MA,Cooper PE,et al.Reversible ethyl chloride Neurotoxicity:a case report[J].Can J Neurol Sci,2018,45(1):119-120.
[20]Abulfadl YS,El-Maraghy NN,Ahmed AAE,et al.Protective effects of thymoquinone on D-galactose and aluminum chloride induced neurotoxicity in rats:biochemical,histological and behavioral changes[J].Neurol Res,2018,40(4):324-333.