CAJ | 학술논문

目的评价二氧化碳(C02)气腹对腹腔镜手术患者顺阿曲库铵肌松效应的影响.方法择期子宫切除术患者60例,年龄35 ～ 60岁,BMI 18～ 24 kg/m2,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将其随机分为2组(n=30):气腹组(P组)和对照组(C组)；每组根据肌松拮抗剂使用情况随机分为2个亚组(n=15):非拮抗组(P0组或C0组)和拮抗组(P1组或C1组).静脉注射芬太尼、丙泊酚、顺阿曲库铵麻醉诱导,气管插管后行机械通气.靶控输注丙泊酚和瑞芬太尼维持麻醉.采用TOF-Watch SX加速度仪监测肌松程度,P组于气腹建立后T1恢复达5％时静脉注射顺阿曲库铵0.05mg/kg,术毕P1组和C1组于 T1恢复至25％时静脉注射新斯的明拮抗,P0组和C0组自然恢复.记录气腹建立后追加顺阿曲库铵的临床作用时间和恢复指数.于诱导前即刻、气腹30 min、60 min及术毕时,分别抽取动脉血样行血气分析.结果与C0组比较,P0组临床作用时间及恢复指数延长(P＜0.05)；与C1组比较,P1组临床作用时间及拮抗恢复指数延长(P＜0.05)；与 C0组比较,P0组于气腹30、60 min、术毕时pH值下降,PaCO2升高(P＜0.05)；与C1组比较,P1组于气腹30、60 min、术毕时pH值下降,PaCO2升高(P＜0.05).结论 CO2气腹可强化顺阿曲库铵的肌松效应,且可延长拮抗后肌松恢复时间.
목적 평개이양화탄(C02)기복대복강경수술환자순아곡고안기송효응적영향.방법 택기자궁절제술환자60례,년령35 ～ 60세,BMI 18～ 24 kg/m2,ASA분급Ⅰ혹Ⅱ급.채용수궤수자표법,장기수궤분위2조(n=30):기복조(P조)화대조조(C조)；매조근거기송길항제사용정황수궤분위2개아조(n=15):비길항조(P0조혹C0조)화길항조(P1조혹C1조).정맥주사분태니、병박분、순아곡고안마취유도,기관삽관후행궤계통기.파공수주병박분화서분태니유지마취.채용TOF-Watch SX가속도의감측기송정도,P조우기복건립후T1회복체5％시정맥주사순아곡고안0.05mg/kg,술필P1조화C1조우 T1회복지25％시정맥주사신사적명길항,P0조화C0조자연회복.기록기복건립후추가순아곡고안적림상작용시간화회복지수.우유도전즉각、기복30 min、60 min급술필시,분별추취동맥혈양행혈 기분석.결과 여C0조비교,P0조림상작용시간급회복지수연장(P＜0.05)；여C1조비교,P1조림상작용시간급길항회복지수연장(P＜0.05)；여 C0조비교,P0조우기복30、60 min、술필시pH치하강,PaCO2승고(P＜0.05)；여C1조비교,P1조우기복30、60 min、술필시pH치하강,PaCO2승고(P＜0.05).결론 CO2기복가강화순아곡고안적기송효응,차가연장길항후기송회복시간.
Objective To investigate the effect of carbon dioxide ( CO2 ) pneumoperitoneum on the neuromuscular block of cisatracurium in patients undergoing laparoscopic operation.Methods Sixty ASA Ⅰ or Ⅱ patients,aged 35-60 yr,with body mass index of 18-24 kg/m2,scheduled for elective hysterectomy,were randomly divided into 2 groups ( n =30 each ):pneumoperitoneum group ( group P) and control group ( group C ).Each group was further divided into 2 subgroups according to the use of the antagonist of neuromuscular block ( n =15 each):no neostigmine group ( group P0 or C0 ) and neostigmine group (group P1 or C1 ).Anesthesia was induced with fentanyl,propofol and cisatracurium and maintained with target-controlled infusion of propofol and remifentanil.Tracheal intubation was performed and the patients were mechanically ventilated.Neuromuscular function was monitored by TOF-Watch SX accelerography (Organon Co.,Organon).A train of four (TOF) stimulation of the ulnar nerve was used.When T,returned to 5％ of control height after CO2 pneumoperitoneum was established,cisatracurium 0.05 mg/kg was injected intravenously in group P.When T1 returned to 25％ of control height after the end of operation,neostigmine was injected intravenously in groups P1 andC1.The clinical duration and recovery index were recorded after CO2 pneumoperitoneum was established.Arterial blood samples were obtained immediately before induction,at 30 and 60 min of pneumoperitoneum,and at the end of operation for blood gas analysis.Results The clinical duration and recovery index were significantly longer in group P0 than in group C0,and in group P1 than in group C1 ( P ＜ 0.05).Compared with group C0,the pH value was significantly decreased and PaCO2 was significantly increased at 30 and 60 min of pneumoperitoneum,and at the end of operation in group P0 ( P ＜ 0.05).Compared with group C1,the pH value was significantly decreased and PaCO2 was significantly increased at 30 and 60 min of pneumoperitoneum,and at the end of operation in group P1 ( P ＜ 0.05).Conclusion CO2 pneumoperitoneum can strengthen the neuromuscular block induced by cisatracurium and prolong the recovery time following antangonism by neostigmine administration in patients undergoing laparoscopic operation.