麻醉复苏室中应用肌松监测仪必要性的临床观察

发布时间：2018-01-14 08:08

  本文关键词：麻醉复苏室中应用肌松监测仪必要性的临床观察　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 肌松残余 肌松监测 顺式阿曲库铵

【摘要】：研究目的:应用肌松监测仪监测患者根据临床指征出麻醉复苏室时肌松残余发生情况,探讨在PACU中应用肌松监测仪对麻醉复苏工作的指导意义。研究方法:选取择期行全麻手术,术后转入麻醉复苏室的患者。ASAⅠ~Ⅲ级,年龄20~90岁,BMI16~28 kg/m2,患者术中仅以顺式阿曲库铵作为肌松药。拔除气管导管入复苏室(拔管组)患者,测量转入复苏室时(T1)、转入复苏室30 min(T2)和出复苏室时(T3)的TOF比值;保留气管导管入复苏室(带管组)患者,测量拔除气管导管即刻(T4)、拔除气管导管后30 min(T5)和出复苏室时(T6)的TOF比值。记录患者人口统计学资料、麻醉用药和肌松拮抗药使用情况、患者在复苏室停留时间及在复苏室期间低氧血症的发生率。研究结果:本研究共纳入306例患者,其中拔管组44例,带管组262例。拔管组T1、T2和T3时刻肌松残余发生率分别为61.4%、43.2%、15.9%;带管组T4、T5和T6时刻肌松残余的发生率分别为76.7%、46.6%、21%。带管组患者最后一次应用肌松药到拔除气管导管的时间≤90 min比90min的患者拔管时肌松残余发生率高(P0.01);老年患者(66~90岁)与青年患者(20~40岁)比较,老年患者出复苏室时肌松残余发生率高(P0.05);出复苏室时TOF比值0.9比≥0.9的患者在复苏室平均停留时间延长(P0.05);而拔除气管导管组患者的各组数据均无统计学差异(P0.05);出室时给予肌松拮抗药患者TOF比值恢复到0.9的平均时间为(8.6±5.0)min;在复苏室停留期间两组患者低氧血症(Sp O290%)的发生率为7.2%。结论:依据临床指征判断指导患者出麻醉复苏室时肌松残余发生率较高,肌松残余阻滞作用可以被肌松拮抗药物短时间内拮抗,在复苏室中应用肌松监测仪判断出室时机,指导患者出复苏室有十分重要的临床意义。
[Abstract]:Objective: to monitor the residual occurrence of muscle relaxation in anaesthesia resuscitation chamber according to clinical indications by using muscle release monitor. To explore the guiding significance of using muscle relaxation monitor in PACU for anesthesia resuscitation. Methods: select the patients with selective general anesthesia operation and transfer to anaesthesia resuscitation room after operation. The patients aged 20 to 90 years old were treated with cis-atracurium as muscle relaxant only. Tracheal catheter was removed to resuscitation chamber (extubation group). The TOF ratios of T _ (1) T _ (1), T _ (2) and T _ (3) were measured when the resuscitation room was transferred into the resuscitation chamber. The trachea catheter was retained into the resuscitation chamber (with tube group) and T4 was measured immediately after tracheal catheter was removed. The TOF ratio of T5 (30 min after extubation) and T6 (T6) after extubation were recorded. The data of the patient's demography, the use of anesthetic and muscle relaxant antagonists were recorded. Results: 306 patients were included in this study, 44 patients in the extubation group, 262 patients in the tube group, and T1 in the extubation group. The residual incidences of muscle relaxation at T2 and T3 were 61.4 and 43.2 / 15.9, respectively. The incidence of residual muscle relaxation at T _ 4, T _ 5 and T _ 6 in the tube group was 76.776% and 46.6%, respectively. 21. The time between the last application of muscle relaxant and the extubation of tracheal duct in the group with tube was less than 90 min, and the residual rate of muscle relaxation in the group with tube was higher than that in the group of 90 minutes (P 0.01). Compared with young patients (aged 20 ~ 40), the residual rate of muscle relaxation in elderly patients was higher than that in young patients (P 0.05). The average residence time of patients with TOF ratio of 0.9 to 鈮，

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