不同诱导剂量顺式阿曲库铵对老年甲状腺癌患者术中喉返神经监测的影响

发布时间：2018-04-10 03:16

  本文选题：顺式阿曲库铵　切入点：老年人　出处：《广东医学》2017年14期

【摘要】：目的比较不同诱导剂量的顺式阿曲库铵对老年甲状腺癌患者术中监测喉返神经功能的影响。方法选择择期行喉返神经监测的老年甲状腺癌患者150例,年龄60~75岁,ASA分级Ⅰ~Ⅱ级,根据顺式阿曲库铵诱导剂量的不同随机分3组,每组50例。麻醉诱导:咪达唑仑0.03 mg/kg,丙泊酚2 mg/kg,芬太尼4μg/kg,以及顺式阿曲库铵0.05 mg/kg(A组)、0.1 mg/kg(B组)、0.15 mg/kg(C组),3 min后且Narcotrend值46时插管(喉返神经监测管)并机械通气。术中泵入丙泊酚、瑞芬太尼和吸入七氟醚维持麻醉。记录3组患者插管前30 s及插管后30 s的收缩压(SBP)、舒张压(DBP)及心率(HR);记录插管时喉镜暴露Cormach-Lehane(C-L)分级情况(Ⅰ~Ⅳ级例数);观察并记录插管时呛咳反应;记录从给完顺式阿曲库铵到喉返神经暴露的时间(T1)、到第1次监测到电信号的时间(T2);记录给完顺式阿曲库铵后40 min(T3)、50 min(T4)、60 min(T5)、70 min(T6)各时间点刺激侧电信号的波峰值。结果与插管前30 s相比,3组患者在插管后30 s的SBP、DBP及HR显著升高(P0.05);与A组相比,B、C两组在插管后30 s的SBP、DBP及HR显著降低(P0.05),插管时C-L分级为Ⅰ级的比例明显升高(P0.05),Ⅱ级的比例明显降低(P0.05),插管时呛咳反应发生率显著降低(P0.05),C组T2时间明显延长(P0.05),在T3时无电信号,在T4、T5时电信号波峰值显著减小(P0.05);B组在T3~T6各时间点电信号波峰值均与A组接近,差异无统计学意义(P0.05)。结论麻醉诱导使用剂量为0.1 mg/kg(即2倍ED95)的顺式阿曲库铵适宜于老年甲状腺癌患者术中行喉返神经功能的监测。
[Abstract]:Objective to compare the effects of different induced doses of cis-atracurium on intraoperative monitoring of recurrent laryngeal nerve function in elderly patients with thyroid carcinoma.Methods 150 elderly patients with thyroid cancer, aged 6075 years, who underwent recurrent laryngeal nerve monitoring (RLN) were randomly divided into 3 groups (50 cases in each group) according to the different doses of cis-atracurium.Anesthesia induction: midazolam 0.03 mg / kg, propofol 2 mg / kg, fentanyl 4 渭 g / kg, and cis atracurium 0. 1 mg/kg(B group were intubated with Narcotrend value 46 min after 0. 15 mg/kg(C group (recurrent laryngeal nerve monitoring tube) and mechanical ventilation.Anesthesia was maintained by pumping propofol, remifentanil and sevoflurane during the operation.Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HRV) were recorded 30 seconds before intubation and 30 hours after intubation, and the classification of Cormach-Lehane C-L (鈪，

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