| 摘要: |
| 目的 探讨妇科腹腔镜手术下二氧化碳气腹对罗库溴铵药效的影响。方法 择期ASA Ⅰ~Ⅱ期妇科腹腔镜手术(L组)和开腹手术(C组)患者各29例,采用全凭静脉麻醉,靶控输注丙泊酚复合瑞芬太尼,肌松采用闭环注射系统输注罗库溴铵:诱导剂量0.6 mg/kg, 维持速度1.8 μg·kg-1·min-1,增药条件设为T1恢复至15%,增药速度30 μg·kg-1·min-1。观察指标包括:罗库溴铵起效时间(T1降至0%)、第1次增药时间(T1恢复至15%)、肌松恢复指数(T1由25%恢复至75%时间)、增药次数以及单位时间输注剂量。记录诱导前(P0)、气管插管后5 min (P1)、气腹后5 min (P2)、气腹后30 min(P3)、气腹后1 h (P4)、气腹结束(P5)、拔出气管导管(P6)各时间点心率(HR)、平均动脉压(MAP)、心输出量(CO)、PaCO2、pH和麻醉深度BIS值。结果 L组罗库溴铵第一次增药时间长于C组[(42.1±10.7) vs (27.7±9.5) min,P<0.01],L组罗库溴铵肌松恢复指数长于C组[(13.8±6.0) vs (9.6±3.9) min,P<0.01],L组罗库溴铵单位时间药量少于C组[(5.4±0.8) vs (6.3±0.5) μg·kg-1·min-1, P<0.05],L组罗库溴铵每小时增药次数少于C组[(2.1±1.0) vs (2.8±0.9)次, P<0.05],L组CO与C组相比在P2~P4时段下降(P<0.01)。结论 二氧化碳气腹下罗库溴铵肌松作用时间延长,肌松作用恢复延迟,用药量降低,可能与气腹后CO下降有关。 |
| 关键词: 二氧化碳 人工气腹 闭环肌松注射系统 罗库溴铵 |
| DOI：10.3724/SP.J.1008.2015.00952 |
| 投稿时间：2015-04-19修订日期：2015-07-22 |
| 基金项目: |
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| Effect of carbon dioxide pneumoperitoneum on pharmacodynamics of rocuronium administered by closed-loop muscle relaxation injection system |
| WEI Wei,HOU Jiong* |
(Department of Anesthesiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the effect of carbon dioxide pneumoperitoneum on pharmacodynamics of rocuronium(ROC) in gynecological laparoscopic surgery. Methods Patients of ASA Ⅰ-Ⅱ scheduled for elective gynecological laparoscopic surgery (Group L, n=29) or open gynecological surgery (Group C, n=29) were given total intravenous anesthesia (TIVA) with propofol and remifentanil. All patients initially received ROC 0.6 mg·kg-1 by 1.8 μg·kg-1·min-1 through closed-loop muscle relaxation injection system. ROC (30 μg·kg-1·min-1) was given to maintain muscle relaxation when T1 reached 15% of control. The onset time of ROC (T1 down to 0%), the first time of ROC injection (T1 reach 15%), recovery index of muscle relaxation (T1 increase from 25% to 75%), frequency of ROC injection and injection dosage per unit time were recorded. The hemodynamic parameters including heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), PaCO2, pH and depth of anesthesia (bispectral index, BIS) were also recorded before intubation (P0), after intubation (P1), 5 min after pneumoperitoneum (P2), 30 min after pneumoperitoneum (P3), 1 h after pneumoperitoneum (P4), the end of pneumoperitoneum (P5) and time of removal of intubation (P6). Results The first time of ROC injection in group L was significantly longer than that in group C ([42.1±10.7] min vs [27.7±9.5] min, P<0.01),and the recovery index of muscle relaxation in group L was significantly longer than that in group C([13.8±6.0] min vs [9.6±3.9] min, P<0.01). The total dosage per unit time of ROC in group L was significantly less than that in group C ([5.4±0.8] μg·kg-1·min-1 vs [6.3±0.5] μg·kg-1·min-1, P<0.05). The frequency of ROC injection in group L was significantly less than that in group C([2.1±1.0] per hour vs [2.8 ±0.9] per hour, P<0.05). Hemodynamically, CO in group L was found significantly lower than that in group C during P2-P4 (P<0.01). Conclusion The duration and recovery time of ROC in patients undergoing laparoscopic surgery under carbon dioxide pneumoperitoneum are prolonged, and smaller dosage is required compared to open gynecological surgery, which is likely due to the lower CO caused by carbon dioxide pneumoperitoneum. |
| Key words: carbon dioxide artificial pneumoperitoneum closed-loop muscle relxation injection system rocuronium |
