肌松监测指导老年患者全麻后气管拔管及传统拔管比较.doc

肌松监测指导老年患者全麻后气管拔管及传统拔管比较【摘要】目的:观察肌松监测下指导老年患者全麻后气管拔管的血液动力学变化及术后肌松残余的发生率。方法:选择老年患者100例,年龄65-75岁,ASAⅠ～Ⅱ级,实施全凭静脉麻醉。随机分为肌松监测下气管拔管组(A组)和传统气管拔管组(B组)各50例。记录各时间点(术前、拔管时、拔管后30min、拔管后1h)的MAP,HR,脑电双频指数(BIS),四个成串刺激(TOF),TOF0.05),拔管后1h的肌松残余(PORC)发生率为0%;传统组MAP,HR均有显著变化(P0.05),after extubation 1 hour of PORC incidence of 0%;the traditional group MAP,HR changes were significant(P0.05)(见表1);拔管后1h的肌松残余(PORC)发生率为0%。B组:拔管时的MAP明显高于术前(P 研究表明,肌松监测下气管拔管组与传统气管拔管组比较,前者明显血流动力学稳定,术后肌松残余发生率低。所以老年患者通过肌松监测指导气管拔管更平稳、安全,适用于临床。 参考文献? [1] Arain SR,Kern S,Ficke DJ,et al.Variability of duration of action of neuromuscular-blocking drugs in elderly patients.Acta Anaesthesiol Scand,2005,49:312-315? [2] Fuchs-Buder T, Eikermann M,et al.Residual neuromuscular blockades. Clinical consequences, frequency and avoidance strategies.Anaesthesist. 2006 Jan;55(1):7-16? [3] Debaene B, Plaud B, Dilly MP, Donati F,et al.Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action.Anesthesiology. 2003 May;98(5):1042-8? [4] Murphy GS, Szokol JW, Marymont JH,et al. Intraoperative acceleromyographic monitoring reduces the risk of residual neuromuscular blockade and adverse respiratory events in the postanesthesia care unit. [J].Anesthesiology, 2008,109(3):389-98? [5] Blobner M,et al.Short acting muscle relaxants: is neuromuscular monitoring still necessary .Anasthesiol Intensivmed Notfallmed Schmerzther. 2009 May;44(5):348-54? [6] 王焕,类维富,陈颖.氨茶碱全麻催醒对BIS值的影响.临床麻醉学杂志,2005,21:271-272 1