肿瘤患者使用去极化肌松药发生Ⅱ相阻滞临床观察.docVIP

肿瘤患者使用去极化肌松药发生Ⅱ相阻滞的临床观察 山西省肿瘤医院麻醉科研究生 雷垣生 导师 ： 赵嘉训 教授 [摘要] 目的 探讨肿瘤患者在全麻手术中使用去极化肌松药（depolarizing neuromuscular blocking drugs）Ⅱ相阻滞(phase II block)的发生情况及发生Ⅱ相阻滞后使用抗胆碱酯酶药(anticholinesterase agents)拮抗对肌松恢复有无影响。方法 26例择期手术患者随机分为A、B两组，分别在诱导期给予不同剂量的氯化琥珀胆碱(suxamethonium chloride or succinylcholine chloride),随后予以0.1%的琥珀胆碱静脉滴注维持肌松，用四个成串刺激（Train-of-Four Stimulation，TOF）监测肌松，对发生Ⅱ相阻滞的患者一组使用新斯的明拮抗，另一组则不使用 。结果 诱导时两组发生TOF衰减的患者数无显著差异；恢复期两组发生Ⅱ相阻滞的患者数亦无显著性差异；发生Ⅱ相阻滞后使用新斯的明拮抗的患者其肌松临床恢复时间明显缩短 。结论 肿瘤患者使用去极化肌松药在诱导期TOF发生衰减的比例相当高（总发生率为91.67%），恢复期发生Ⅱ项阻滞的比例更高（总发生率96.15%），用新斯的明能有效的拮抗肌松。 关键词 肿瘤患者 去极化肌松药 Ⅱ相阻滞 Clinical observation of tumor patients on phase II block with depolarizing neuromuscular blocking drugs ABSTRACT Objective：To investigate the clininal problem of tumor patients during operation:to observe the occurrence of phase II block and to study the effect on recovery of muscular relaxant with acetyl-cholinesterase inhibitor. Methods：26 hospitalized tumor patients were randomly divided into two group:Group A accepted 1.5mg/kg and Group B accepted 1mg/kg succinylcholine respectively during induction of anesthesia ,then continous 0.1% succinylcholine infusion to maintain muscular relaxant.Ulnar nerve was stimulated with train-of-four(interval=12sec,frequency=2Hz) via surface elec- trodes at the wrist. The TOF was used to monitoring of neuromuscular function.antagonism of a phase II block.The Group A patients of phase II block was antagonized by a cholinesterase inhibitor (neostigmine) . Results：The patients of TOF fade during induction of anesthesia were not statistically significantly different.The recovery time of train-of-four in patients of phase II block with acetyl-cholinesterase inhibitor was significantly short. Conclusion：The tumor patients with depolarizing neuromuscular blocking drugs during induction of anesthesia had a higher rate of train-of-four (91.67%).The rate of phase II block during recovery of anesthesia was 96.15%. antagonism of residual pha