肌松监测在普通外科静吸复合麻醉患者麻醉恢复期的应用效果
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摘要
目的研究肌松监测在普通外科静吸复合麻醉患者麻醉恢复期的应用效果。方法选择2016年1月～2017年6月我院收治的例行全麻择期手术患者82例,随机分为观察组和对照组,每组各41例。观察组采用4个成串刺激(TOF)监测指导拔管,对照组采用经验指导拔管,两组患者均采用静吸复合全身麻醉。观察组患者行肌松监测,在手术结束后TOF比值为0.9,同时具有临床拔管征象时拔出导管,对照组患者根据临床经验拔出气管导管。比较两组患者手术基本情况,不同时间血压及心率变化,出现低氧血症等不良反应发生情况。结果观察组手术结束至拔管时间长于对照组(P <0.05),麻醉剂残余效应浓度低于对照组(P <0.05);对照组患者出现高血压、低氧血症、心跳过急及肌松残余人数均高于观察组患者(P <0.05)。结论肌松监测在静吸复合麻醉患者的拔管时间长于经验拔管组,降低低氧血症及肌松残余人数,安全性较高,值得在临床上推广使用。
Objective To study the effect of neuromuscular monitoring in the recovery period of general surgery patients under combined intravenous and inhalation anesthesia. Methods Eighty-two patients undergoing elective general anesthesia operation in our hospital from January 2016 to June 2017 were selected and randomly divided into observation group and control group,41 cases in each group.The observation group was monitored by a trainof-four(TOF)stimulus to guide extubation,while the control group was given experience guidance for extubation.Intravenous inhalation combined with general anesthesia was used in both groups.The patients in the observation group were monitored for muscle relaxation.After the operation,the TOF ratio was 0.9.At the same time,the catheter was pulled out when there were signs of clinical extubation.The patients in the control group were pulled out according to clinical experience.The basic conditions of operation,changes of blood pressure and heart rate at different time and occurrence of adverse reactions such as hypoxemia were compared between the two groups. Results The time from the end of operation to extubation in the observation group was longer than that in the control group(P < 0.05),and the concentration of anesthetics residual effect was lower than that in the control group(P < 0.05);the number of patients with hypertension,hypoxemia,tachycardia and muscle relaxation in the control group was higher than that in the observation group(P < 0.05). Conclusion The neuromuscular monitoring in patients with intravenous inhalation combined with anesthesia takes longer to extubate than that in the experienced extubation group,which can reduce the number of hypoxemia and residual muscle relaxation.That has higher safety.It is worth popularizing in clinical practice.
Objective To study the effect of neuromuscular monitoring in the recovery period of general surgery patients under combined intravenous and inhalation anesthesia. Methods Eighty-two patients undergoing elective general anesthesia operation in our hospital from January 2016 to June 2017 were selected and randomly divided into observation group and control group,41 cases in each group.The observation group was monitored by a trainof-four(TOF)stimulus to guide extubation,while the control group was given experience guidance for extubation.Intravenous inhalation combined with general anesthesia was used in both groups.The patients in the observation group were monitored for muscle relaxation.After the operation,the TOF ratio was 0.9.At the same time,the catheter was pulled out when there were signs of clinical extubation.The patients in the control group were pulled out according to clinical experience.The basic conditions of operation,changes of blood pressure and heart rate at different time and occurrence of adverse reactions such as hypoxemia were compared between the two groups. Results The time from the end of operation to extubation in the observation group was longer than that in the control group(P < 0.05),and the concentration of anesthetics residual effect was lower than that in the control group(P < 0.05);the number of patients with hypertension,hypoxemia,tachycardia and muscle relaxation in the control group was higher than that in the observation group(P < 0.05). Conclusion The neuromuscular monitoring in patients with intravenous inhalation combined with anesthesia takes longer to extubate than that in the experienced extubation group,which can reduce the number of hypoxemia and residual muscle relaxation.That has higher safety.It is worth popularizing in clinical practice.
引文
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[4]赵伟新.60例全麻患者肌松监测下气管拔管的效果分析[A].中华高血压杂志社.全国高血压防治知识推广培训班暨健康血压中国行福建漳州会论文综合刊[C].中华高血压杂志社:中华高血压杂志社,2014:1.
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[6]Balsalobre-Fernández C,Tejero-González CM,del Campo-Vecino J.Hormonal and neuromuscular responses to high-level middle-and long-distance competition[J].Int J Sports Physiol Perform,2014,9(5):839-844.
[7]赖尚导,曾金祥,曾振平,等.依托咪酯全麻患者肌松监测下气管拔管和传统气管拔管效果差异的研究[J].中国医药导报,2015,36(12):110-113.
[8]Copeland GP,Jones D,Walters M.POSSUM:a scoring system for surgical audit[J].Br J Surg,1991,78(3):355-360.
[9]王文凯,郭文斌,陈慧琦.右美托咪定对重度子痫前期剖宫产患者全身麻醉恢复期气管拔管反应的影响[J].中国医药导报,2016,37(7):59-63.
[10]吕兰,陶刚,魏官峰.肌松监测下老年患者术后拔管安全性和有效性观察[J].西南军医,2017,19(4):321-323.
[11]Brunelli DT,Rodrigues A,Lopes WA.Monitoring of immunological parameters in adolescent basketball athletes during and after a sports season[J].J Sports Sci,2014,32(11):1050-1059.
[12]尹橙,薛纪秀.患者在清醒或镇静状态下校准定标对术后肌松监测指标的影响[J].首都医科大学学报,2013,34(5):651-654.
[13]Brlea S,Breen P.Changes in the electrical properties of the electrode-skin-underlying tissue composite during a weeklong programme of neuromuscular electrical stimulation[J].Physiological Measurement,2014,35(2):231-252.
[14]Murphy GS,Szokol JW,Marymont JH,et al.R esidual neuromuscular blockade and critical respiratory events in the postanesthesia care unit[J].Anesth Analg,2008,107(1):130-137.
[15]卢纯玲,蔚会清.老年患者在肌松监测下进行气管拔管对血流动力学及肌松残余的影响[J].中华保健医学杂志,2017,19(4):351-352.
[2]惠志成,谢冬辉.肌松监测仪在胃癌切除患者麻醉中的效果观察[J].中国医疗器械信息,2017,23(4):14-15.
[3]Hou Y,Wang Q,Fuhai JI.Clinical study on muscle–relaxation effects of domestic rocuronium[J].Shanghai Med J,2013,36(4):316-319.
[4]赵伟新.60例全麻患者肌松监测下气管拔管的效果分析[A].中华高血压杂志社.全国高血压防治知识推广培训班暨健康血压中国行福建漳州会论文综合刊[C].中华高血压杂志社:中华高血压杂志社,2014:1.
[5]MCCAUL C,TOBIN E,BOYLAN J,et al.Atracurium is associated with postoperative residual curarization[J].Br J Anaesth,2002,89(5):766-769.
[6]Balsalobre-Fernández C,Tejero-González CM,del Campo-Vecino J.Hormonal and neuromuscular responses to high-level middle-and long-distance competition[J].Int J Sports Physiol Perform,2014,9(5):839-844.
[7]赖尚导,曾金祥,曾振平,等.依托咪酯全麻患者肌松监测下气管拔管和传统气管拔管效果差异的研究[J].中国医药导报,2015,36(12):110-113.
[8]Copeland GP,Jones D,Walters M.POSSUM:a scoring system for surgical audit[J].Br J Surg,1991,78(3):355-360.
[9]王文凯,郭文斌,陈慧琦.右美托咪定对重度子痫前期剖宫产患者全身麻醉恢复期气管拔管反应的影响[J].中国医药导报,2016,37(7):59-63.
[10]吕兰,陶刚,魏官峰.肌松监测下老年患者术后拔管安全性和有效性观察[J].西南军医,2017,19(4):321-323.
[11]Brunelli DT,Rodrigues A,Lopes WA.Monitoring of immunological parameters in adolescent basketball athletes during and after a sports season[J].J Sports Sci,2014,32(11):1050-1059.
[12]尹橙,薛纪秀.患者在清醒或镇静状态下校准定标对术后肌松监测指标的影响[J].首都医科大学学报,2013,34(5):651-654.
[13]Brlea S,Breen P.Changes in the electrical properties of the electrode-skin-underlying tissue composite during a weeklong programme of neuromuscular electrical stimulation[J].Physiological Measurement,2014,35(2):231-252.
[14]Murphy GS,Szokol JW,Marymont JH,et al.R esidual neuromuscular blockade and critical respiratory events in the postanesthesia care unit[J].Anesth Analg,2008,107(1):130-137.
[15]卢纯玲,蔚会清.老年患者在肌松监测下进行气管拔管对血流动力学及肌松残余的影响[J].中华保健医学杂志,2017,19(4):351-352.