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体温对罗库溴铵残余肌松恢复和拮抗效果的影响
The effect of intraoperative warming on the recovery and antagonism of rocuronium-induced residual neuromuscular blockade.

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DOI:
作者:
刘伍 李士通
LIU Wu, LI Shitong
作者单位:
上海市第一人民医院
Department of Anesthesiology, Shanghai First People’s Hospital, Shanghai Jiaotong University, Shanghai 200080
关键词:
术中保温；罗库溴铵；肌松恢复，肌松拮抗
intraoperative warming; rocuronium; neuromuscular blockade recovery; neuromuscular blockade antagonism
摘要:
目的：观察在使用罗库溴铵的全麻病人中，术中保温对术后肌松恢复和残余肌松拮抗效果的影响。 方法： 40例全麻手术病人随机分为四组：不保温术后肌松自然恢复组（Ⅰ组）、不保温术后残余肌松拮抗组（Ⅱ组）、保温自然恢复组（Ⅲ组）、保温拮抗组（Ⅳ组），每组10例。异丙酚、芬太尼和0.6mg/kg罗库溴铵诱导插管，术中使用TOF-Swatch检测仪监测，T1恢复至25%时给予罗库溴铵0.15mg/kg。保温组用热毯加覆盖法保持体温。手术结束后当TOFR值恢复到0.6，用新斯的明0.015mg/kg和阿托品0.5mg拮抗肌松。观察并比较各组TOFR从0.6恢复至0.9的时间。结果：保温组与不保温组平均温度有统计学差异（36.7℃ vs 35.8℃，P＜0.05）。保温与不保温组的TOFR从0.6至0.9自然恢复时间有显著统计学差异（15.5±2.59min vs 19.5±6.33min， P＜0.05）。保温与不保温组的拮抗后恢复时间也有显著统计学差异（3.9±1.37min vs 6.3±1.95min，P＜0.05）；拮抗恢复显著快于自然恢复（P＜0.01）。结论：术中保温有助于病人罗库溴铵术后的肌松恢复和拮抗。
[abstract] Objective: To investigate the effect of intraoperative warming on the recovery from rocuronium-induced postoperative residual neuromuscular blockade and on its antagonism with small dose of neostigmine. Methods: Forty patients for elective surgeries were randomly divided into four groups: groupⅠ, without warming and allowing spontaneous recovery of rocuronium-induced neuromuscular blockade; group Ⅱ, warming and allowing spontaneous recovery; group Ⅲ, without warming but antagonizing the residual neuromuscular blockade with small dose of neostigmine; group Ⅳ, warming and antagonizing (n=10 each). General anesthesia was induced with intravenous propofol, fentanyl and rocuronium 0.6mg/kg.The neuromuscular transmission was monitored by TOF-Watch SX® acceleromyograph. Rocuronium was given when T1 recoverd to 25%.Patients were covered and electric blanket were used in warming group. The residual neuromuscular blockade was antagonized with atropine 0.5mg and neostigmine 0.015mg/kg in antagonism group when the TOFR reaching 0.6.The intervals of TOFR recovering from 0.6 to 0.9 were recorded. Results: There was significant difference in body core temperature between group with and without warming(36.7℃ vs 35.8℃,P＜0.05). There was significant difference in the recovery intervals both between groupⅠand Ⅲ(3.9±1.37min vs 6.3±1.95min,P＜0.05)and between groupⅡand Ⅳ(15.5±2.59min vs 19.5±6.33min, P＜0.05). The recovery in antagonizing groups was much faster than those in spontaneous groups (P＜0.01). Conclusion: Intraoperative warming accelerates spontaneous recovery and antagonizing from postoperative rocuronium-induced neuromuscular blockade.

 

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