国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2009年
2期
109-111,155
,共4页
张广防%徐建设%赵振龙%古妙宁
張廣防%徐建設%趙振龍%古妙寧
장엄방%서건설%조진룡%고묘저
肌松监测%罗库溴铵%气管插管条件%声门暴露程度
肌鬆鑑測%囉庫溴銨%氣管插管條件%聲門暴露程度
기송감측%라고추안%기관삽관조건%성문폭로정도
Neuro-musealar monitoring%Rocumnium%Intubation condition%Glottic exposure
目的 比较肌松监测下静脉注射罗库溴铵0.9mg/kg后60秒和4个成串刺激(train-of-four,TOF)的T1达到最大抑制程度时的气管插管条件,探讨该药理想的气管插管时机.方法 120例行择期腹腔镜胆囊切除术患者,年龄18岁～60岁,ASA Ⅰ-Ⅱ级,随机均分为两组.分别于静脉注射罗库溴铵0.9 mg/kg后60秒(A组)或T1达到最大抑制程度时(B组)行气管插管.观察并记录两组罗库溴铵起效时间(TOF的T1达到最大抑制程度的时间)、气管插管条件(Cooper's评分)、声门暴露程度(Cormack-Lehane分级)、诱导过程中的心率(heart rate,HR)和收缩压(systolic blood pressuref,SBP)变化以及术后24 h咽喉并发症(喉痛、声嘶等不适).结果 静注罗库溴铵0.9 mg/kg后66.0秒±18.1秒(95%可信区间30.2秒一101.8秒)达到T1最大抑制.B组Cooper's评分和Cormack-Lehane分级均优于A组(P<O.05).插管后两组HR和SBP较插管前明显升高(P<O.05),A组SBP升高程度大于B组(P<0.05).两组术后声嘶发生率差异无统计学意义.A组咽喉疼痛发生率显著高于B组(P<0.05).结论 静脉注射罗库溴铵0.9 mg/kg后T1达到最大抑制程度时比给药后60秒时的气管插管条件更满意,罗库溴铵0.9 mg/kg理想的气管插管时机是给药101.8秒后.
目的 比較肌鬆鑑測下靜脈註射囉庫溴銨0.9mg/kg後60秒和4箇成串刺激(train-of-four,TOF)的T1達到最大抑製程度時的氣管插管條件,探討該藥理想的氣管插管時機.方法 120例行擇期腹腔鏡膽囊切除術患者,年齡18歲～60歲,ASA Ⅰ-Ⅱ級,隨機均分為兩組.分彆于靜脈註射囉庫溴銨0.9 mg/kg後60秒(A組)或T1達到最大抑製程度時(B組)行氣管插管.觀察併記錄兩組囉庫溴銨起效時間(TOF的T1達到最大抑製程度的時間)、氣管插管條件(Cooper's評分)、聲門暴露程度(Cormack-Lehane分級)、誘導過程中的心率(heart rate,HR)和收縮壓(systolic blood pressuref,SBP)變化以及術後24 h嚥喉併髮癥(喉痛、聲嘶等不適).結果 靜註囉庫溴銨0.9 mg/kg後66.0秒±18.1秒(95%可信區間30.2秒一101.8秒)達到T1最大抑製.B組Cooper's評分和Cormack-Lehane分級均優于A組(P<O.05).插管後兩組HR和SBP較插管前明顯升高(P<O.05),A組SBP升高程度大于B組(P<0.05).兩組術後聲嘶髮生率差異無統計學意義.A組嚥喉疼痛髮生率顯著高于B組(P<0.05).結論 靜脈註射囉庫溴銨0.9 mg/kg後T1達到最大抑製程度時比給藥後60秒時的氣管插管條件更滿意,囉庫溴銨0.9 mg/kg理想的氣管插管時機是給藥101.8秒後.
목적 비교기송감측하정맥주사라고추안0.9mg/kg후60초화4개성천자격(train-of-four,TOF)적T1체도최대억제정도시적기관삽관조건,탐토해약이상적기관삽관시궤.방법 120례행택기복강경담낭절제술환자,년령18세～60세,ASA Ⅰ-Ⅱ급,수궤균분위량조.분별우정맥주사라고추안0.9 mg/kg후60초(A조)혹T1체도최대억제정도시(B조)행기관삽관.관찰병기록량조라고추안기효시간(TOF적T1체도최대억제정도적시간)、기관삽관조건(Cooper's평분)、성문폭로정도(Cormack-Lehane분급)、유도과정중적심솔(heart rate,HR)화수축압(systolic blood pressuref,SBP)변화이급술후24 h인후병발증(후통、성시등불괄).결과 정주라고추안0.9 mg/kg후66.0초±18.1초(95%가신구간30.2초일101.8초)체도T1최대억제.B조Cooper's평분화Cormack-Lehane분급균우우A조(P<O.05).삽관후량조HR화SBP교삽관전명현승고(P<O.05),A조SBP승고정도대우B조(P<0.05).량조술후성시발생솔차이무통계학의의.A조인후동통발생솔현저고우B조(P<0.05).결론 정맥주사라고추안0.9 mg/kg후T1체도최대억제정도시비급약후60초시적기관삽관조건경만의,라고추안0.9 mg/kg이상적기관삽관시궤시급약101.8초후.
Objective To investigate the timing of tracheal intubafion with rocuronium relaxation based on neuro-muscular monitoring.Methods One hundred and twenty patients undergoing elective laparoseopic cholecystectomy were randomly divid-ed into two groups(n=60).Tracheal intubation performed 60 s after a bolus dose of 0.9 mg/kg rocuronium(group A)or at maximal T1 depression based on neuromuscular monitoring (group B).Glottic exposure and intubation condition were evaluated with Cormack-Lehane classification and Cooper's score,respectively.HR,SBP and time to maximal T1 depression Were record-ed during induction.Hoarseness and sore throat were observed in first postoperative day.Results Time to maximal T1 de-pression after rocuronium injection was(66.0±18.1)s (95%confidence interval 30.2 s-101.8 s).Coopor's score and Cormack's classification in group B was superior to that in group A(P<O.05).HR and SBP increased significantly after tracheal intuba-tion(P<0.05)in both groups,with more increasing extent in group A(P<0.05).The incidence of hoarseness was comparable between both groups.with higher incidence of sore throat in group A than in group B(P<O.05).Conclusion Neuro-muscular monitoring enables to get better intubation condition.More than 101.8 s after a bolus dose of 0.9 mg/kg rocu.Fonium may be the ideal time for tracheal intubation.
