不同非去极化肌松药对老年患者全凭吸入麻醉术后围拔管期残余肌松发生情况影响.doc

不同肌松药残余肌松发生894169219@ 【摘要】 目的 评价3种非去极化肌松药残余肌松发生年龄65岁，ASA分级Ⅰ～Ⅲ级罗库溴铵组（）、顺式阿曲库铵组（）及维库溴铵组（）仪监测左侧外展前臂尺神经拇内收肌收缩情况脑电活动监测仪测定BIS值静脉注射咪达唑仑0.05 mg／kg，舒芬太尼0.μg/kg，异丙酚1.5～2 mgkg。患者入睡肌松监测仪定标后，组0.9 mg/kg,、顺式阿曲库铵0.15 mg/kg及维库溴铵0.12 mg/kg。七氟醚维持麻醉深度维持BIS值40～60。术中根据肌松监测仪显示第一个肌颤搐恢复到25%时追加肌松药追加0.3 mg/kg、顺式阿曲库铵0.05 mg/kg及维库溴铵0.04 mg/kg。记录各组麻醉恢复期肌松恢复指标: 末次用药至拔管时间、临床时效(第一个肌颤搐恢复到25%时间)、恢复指数(第一个肌颤搐从25%恢复到75%的时间)，记录术毕时(T)、拔管时(T)、拔管后30 min(T)及拔管后1 h (T)4个时点TOFR0.7和TOFR0.9患者例数当TOFR0.9时提示残余肌松。TOFR0.7、TOFR0.9发生例数均为50例（100%），差异无统计学意义(P＞0.05)。与B组相比，A组、C组T2、T3、T4时TOFR0.7和TOFR0.9发生几率明显降低(P0.05)，末次用药至拔管时间、临床时效及恢复指数明显降低(P0.01)。结论 应用顺式阿曲库铵可降低老年患者全身麻醉残余肌松发生神经肌肉非去极药【Abstract】 Objective Evaluation of 3 kinds of non depolarizing muscle relaxants on elderly patients with general anesthesia of residual neuromuscular blockade distribution.Method Choice of anesthesia for elective operation to 150 cases of elderly patients, male or female, age 65~87 years old, weight of 54-74 kg, ASA grade Ⅰ -Ⅲ.Using a random number table, which can be divided into 3 groups (n=50): rocuronium group (group A), cisatracurium group (group B) and vecuronium group (C group).Patients before induction of anaesthesia, muscle relaxation monitor left abducens forearm ulnar nerve adductor pollicis muscle contraction, brain electrical activity monitor for determination of BIS value.Induction of anaesthesia: intravenous midazolam 0.05 mg / kg, sufentanil 0.7 μ g/kg, propofol 1.5-2 mg/kg.The patient to sleep muscle relaxation monitor calibration, A group, B group, C group were intravenous injection of rocuronium 0.9 mg/kg, atracurium, CIS 0.15 0.12 mg/kg mg/kg and vecuronium.Anesthesia was maintained with sevoflurane inhalation anesthesia depth: maintain, maintain BIS value 40 ～ 60.Intraoperative according to muscle relaxation monitor displays the first twitch back to 25% when an additional muscle relaxants, A group, B group, C group were additional rocuronium 0.3 mg/kg, cisatracurium in 0.05 mg/kg and 0.04 mg/kg of vecuronium bromide.Anesthe