CAJ | 학술논문

目的：研究老年患者术后使用新斯的明拮抗顺式阿曲库铵肌松药残留阻滞作用的量效关系。方法选择深圳市第二人民医院2013年2~9月在全凭静脉麻醉下行腹腔镜胆囊摘除术的老年患者80例，分为4组，每组各20例，即T0，T5，T10和T20组。术后当4个成串刺激比值(TOFR)恢复至0.5时，T5，T10和T20组患者分别静脉注射新斯的明5，10，20μg/kg，而T0组注射生理盐水。记录TOFR恢复到1.0的时间，记录给药前及给药后第3、5、10分钟的心率(HR)，血压(BP)的变化，计算各组10min内TOFR成功恢复到1.0的百分率，以及术后6h恶心呕吐的发生率。结果①T0组比较，T20组TOFR恢复到1.0时间明显缩短，T20组中10min内TOFR成功恢复到1.0的百分率增加，差异有统计学意义(P<0.05)；而T5组及T10组在TOFR恢复到1.0时间以及10min内TOFR成功恢复到1.0的百分率与T0组比较，差异无统计学意义(P>0.05)。②T20组在第3、5、10分钟的HR与给药前比较明显降低，差异有统计学意义(P<0.05)。T0组、T5组及T10组在给药前后HR变化差异无统计学意义(P>0.05)，各组给药前后BP变化差异无统计学意义(P>0.05)。③各组术后6h恶心呕吐发生率差异无统计学意义(P>0.05)。结论在老年患者腹腔镜胆囊切除术后，当TOFR恢复至0.5时，使用20μg/kg新斯的明可有效的拮抗顺式阿曲库铵的残留作用，20μg/kg剂量新斯的明可导致老年患者心率减慢，但不增加术后恶心呕吐发生率。
목적：연구노년환자술후사용신사적명길항순식아곡고안기송약잔류조체작용적량효관계。방법선택심수시제이인민의원2013년2~9월재전빙정맥마취하행복강경담낭적제술적노년환자80례，분위4조，매조각20례，즉T0，T5，T10화T20조。술후당4개성천자격비치(TOFR)회복지0.5시，T5，T10화T20조환자분별정맥주사신사적명5，10，20μg/kg，이T0조주사생리염수。기록TOFR회복도1.0적시간，기록급약전급급약후제3、5、10분종적심솔(HR)，혈압(BP)적변화，계산각조10min내TOFR성공회복도1.0적백분솔，이급술후6h악심구토적발생솔。결과①T0조비교，T20조TOFR회복도1.0시간명현축단，T20조중10min내TOFR성공회복도1.0적백분솔증가，차이유통계학의의(P<0.05)；이T5조급T10조재TOFR회복도1.0시간이급10min내TOFR성공회복도1.0적백분솔여T0조비교，차이무통계학의의(P>0.05)。②T20조재제3、5、10분종적HR여급약전비교명현강저，차이유통계학의의(P<0.05)。T0조、T5조급T10조재급약전후HR변화차이무통계학의의(P>0.05)，각조급약전후BP변화차이무통계학의의(P>0.05)。③각조술후6h악심구토발생솔차이무통계학의의(P>0.05)。결론재노년환자복강경담낭절제술후，당TOFR회복지0.5시，사용20μg/kg신사적명가유효적길항순식아곡고안적잔류작용，20μg/kg제량신사적명가도치노년환자심솔감만，단불증가술후악심구토발생솔。
Objective To investigate the dose-effect relationship of neostigmine to antagonize Cisatracurium residual paralysis after surgery in elderly patients. Methods From February to September 2013, in the Second People's Hospital of Shenzhen City, 80 elderly patients with scheduled for elective laparoscopic cholecystectomy under total intravenous anesthesia were selected, and devided into 4 groups post operation, 20 cases in each group. Patients in T5 group, T10 group and T20 group were given 5, 10, 20μg/kg Neostigmine respectively, while T0 group was given saline, when Train-Of-Four Ratio (TOFR) returned to 0.5 after surgery. Time to TOFR 1.0, blood pressure (BP) and heart rate (HR) before administered and at the end of 3, 5,10 min after administered were recorded. The ratio of successful reversal within 10 min and postoperative nausea and vomiting after 6 h of each group were calculated. Results①Compared with T0 group, the time to TOFR 1.0 of T20 group was significantly short, and the ratio of successful reversal to TOFR 1.0 within 10 minutes of T20 group was increased, the differences were statistically significant (P < 0.05), while compared with T0 group, the time to 1.0 and the ratio of successful reversal of T5 group and T0 group, the differences were not statistically significant (P>0.05).②HR of T20 group was significantly lower at the end of 3,5 and 10 min after administered com-pared with before administered, the differences were statistically significant (P< 0.05). There was no statistical differ-ence of HR of T0 group,T5 group,and T10 group between before and after administered (P> 0.05). There was no statisti-cal difference of BP of each group between before and after administered (P>0.05).③There was no statistical differ-ence of PONV of each group after 6 h (P > 0.05). Conclusion For successful reversal the residual paralysis of cisatracurium within 10 minutes after laparoscopic cholecystectomy surgery in elderly, 20μg/kg neostigmine is needed when given at TOFR 0.5. 20 μg/kg of neostigmine is associated with lower heart rate in elderly patients, but does not increase the incidence of PONV.