CAJ | 학술논문

目的观察硬膜外麻醉对快通道结肠外科患者罗库溴铵药效的影响.方法将40例择期行快速康复腹腔镜结肠手术的患者随机分成两组:A组(全凭静脉麻醉组,术后给予静脉镇痛)和B组(静脉复合硬膜外麻醉组,于T9 ～ T10硬膜外穿刺置管,注射0.375％的罗哌卡因10 ml后每小时注射6 ml上述溶液直至手术结束并用于术后镇痛).静脉注射0.5 μg/kg舒芬太尼后,以3.5 mg/L为起始血浆药物浓度靶控输注丙泊酚,以0.1μg/(kg·min)为起始剂量持续输注瑞芬太尼,患者意识消失后注射0.9 mg/kg罗库溴铵,当1 Hz的单刺激达到最大阻滞时行气管插管.根据Nacotrend指数调整丙泊酚的靶控输注浓度.调整瑞芬太尼的输注剂量,使平均动脉压(MAP)维持在基础值的80％～120％.根据肌松监测结果追加罗库溴铵0.3 mg/kg,记录肌松剂的起效时间、作用时间和追加次数.手术结束时停止输注丙泊酚、瑞芬太尼,记录拔管时间.患者于麻醉复苏室(PACU)行肌松监测了解肌松残余情况.结果罗库溴铵的起效时间在两组中差异无统计学意义(P＞0.05).B组每次追加肌松剂的间隔时间均长于A组,差异有统计学意义(P＜0.05),加药次数少于A组(P＜0.05),拔管时间明显短于A组(P＜0.05).肌松残余的发生率和持续时间A组均高于B组(P＜0.05).结论全身麻醉联合硬膜外阻滞在快通道结肠外科麻醉中可延长肌松剂罗库溴铵的作用时间,减少其使用次数;减少肌松残余的发生率和持续时间;提高术后恢复质量.
목적 관찰경막외마취대쾌통도결장외과환자라고추안약효적영향.방법 장40례택기행쾌속강복복강경결장수술적환자수궤분성량조:A조(전빙정맥마취조,술후급여정맥진통)화B조(정맥복합경막외마취조,우T9 ～ T10경막외천자치관,주사0.375％적라고잡인10 ml후매소시주사6 ml상술용액직지수술결속병용우술후진통).정맥주사0.5 μg/kg서분태니후,이3.5 mg/L위기시혈장약물농도파공수주병박분,이0.1μg/(kg·min)위기시제량지속수주서분태니,환자의식소실후주사0.9 mg/kg라고추안,당1 Hz적단자격체도최대조체시행기관삽관.근거Nacotrend지수조정병박분적파공수주농도.조정서분태니적수주제량,사평균동맥압(MAP)유지재기출치적80％～120％.근거기송감측결과추가라고추안0.3 mg/kg,기록기송제적기효시간、작용시간화추가차수.수술결속시정지수주병박분、서분태니,기록발관시간.환자우마취복소실(PACU)행기송감측료해기송잔여정황.결과 라고추안적기효시간재량조중차이무통계학의의(P＞0.05).B조매차추가기송제적간격시간균장우A조,차이유통계학의의(P＜0.05),가약차수소우A조(P＜0.05),발관시간명현단우A조(P＜0.05).기송잔여적발생솔화지속시간A조균고우B조(P＜0.05).결론 전신마취연합경막외조체재쾌통도결장외과마취중가연장기송제라고추안적작용시간,감소기사용차수;감소기송잔여적발생솔화지속시간;제고술후회복질량.
Objective To evaluate the effecof epidural anesthesion pharmacodynamicof rocuronium of patienundergone fastrack surgery of the colon operation.Method40 patientundergoing elective fast-track colon surgery were enrolled in thistudy and were randomly allocated to two groups.The patientin group received total intravenouanaesthesi(TIVA) and postoperative intravenouanalgesia.Aftesuccessful and confirmed epidural catheterization in T9-T10, patientin group received 10 ml 0.375％ ropivacaine followed by 6 ml boloupeone hourvithe epidural catheteuntil the end of surgery, and they received epidural analgesia.Then general anesthesiwainducted with Ⅳ 0.5 μg/kg sulfentanil, taget-controlled infusion (TCI) of 3.5 mg/L propfol, 0.1 μg/(kg· min) remifentanil, aftelosof consciousness, 0.9 mg/kg rocuronium wainjected.Intubation waperformed unlesT1/T=0 appeared in TOF-WATCH, according to which we should add rocuroniumin dose of 0.3 mg/kg when two ballism appeared in machine.Onsetime、effecduration and adding frequency of rocuronium and extubation time were recorded.In anesthesirecovery room (PACU) , residual neuromusculablock wameasured.ResultThere wano significandifference in onsetime of rocuronium between two group(P ＞ 0.05).The duration of rocuronium in group walongethan in group (P ＜ 0.05).And frequency of adding medicine ilesin group (P ＜ 0.05).And extubation time in group walongethan which in group (P ＜ 0.05).The incidence rate and duration of residual neuromusculablock in group were more than in group (P ＜ 0.05).Conclusion The general anesthesicombined epidural block and epidural postoperative analgesi(PCEA) and muscle relaxanmonitoring fofastrack colon surgery could prolong the action time of rocuronium during operation;reduce the incidence rate and duration of remainof musel relaxants;and improve postoperative recovery quality.