發(fā)布時(shí)間：2018-01-14 08:08

  本文關(guān)鍵詞：麻醉復(fù)蘇室中應(yīng)用肌松監(jiān)測(cè)儀必要性的臨床觀察　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 肌松殘余 肌松監(jiān)測(cè) 順式阿曲庫(kù)銨

【摘要】：研究目的:應(yīng)用肌松監(jiān)測(cè)儀監(jiān)測(cè)患者根據(jù)臨床指征出麻醉復(fù)蘇室時(shí)肌松殘余發(fā)生情況,探討在PACU中應(yīng)用肌松監(jiān)測(cè)儀對(duì)麻醉復(fù)蘇工作的指導(dǎo)意義。研究方法:選取擇期行全麻手術(shù),術(shù)后轉(zhuǎn)入麻醉復(fù)蘇室的患者。ASAⅠ~Ⅲ級(jí),年齡20~90歲,BMI16~28 kg/m2,患者術(shù)中僅以順式阿曲庫(kù)銨作為肌松藥。拔除氣管導(dǎo)管入復(fù)蘇室(拔管組)患者,測(cè)量轉(zhuǎn)入復(fù)蘇室時(shí)(T1)、轉(zhuǎn)入復(fù)蘇室30 min(T2)和出復(fù)蘇室時(shí)(T3)的TOF比值;保留氣管導(dǎo)管入復(fù)蘇室(帶管組)患者,測(cè)量拔除氣管導(dǎo)管即刻(T4)、拔除氣管導(dǎo)管后30 min(T5)和出復(fù)蘇室時(shí)(T6)的TOF比值。記錄患者人口統(tǒng)計(jì)學(xué)資料、麻醉用藥和肌松拮抗藥使用情況、患者在復(fù)蘇室停留時(shí)間及在復(fù)蘇室期間低氧血癥的發(fā)生率。研究結(jié)果:本研究共納入306例患者,其中拔管組44例,帶管組262例。拔管組T1、T2和T3時(shí)刻肌松殘余發(fā)生率分別為61.4%、43.2%、15.9%;帶管組T4、T5和T6時(shí)刻肌松殘余的發(fā)生率分別為76.7%、46.6%、21%。帶管組患者最后一次應(yīng)用肌松藥到拔除氣管導(dǎo)管的時(shí)間≤90 min比90min的患者拔管時(shí)肌松殘余發(fā)生率高(P0.01);老年患者(66~90歲)與青年患者(20~40歲)比較,老年患者出復(fù)蘇室時(shí)肌松殘余發(fā)生率高(P0.05);出復(fù)蘇室時(shí)TOF比值0.9比≥0.9的患者在復(fù)蘇室平均停留時(shí)間延長(zhǎng)(P0.05);而拔除氣管導(dǎo)管組患者的各組數(shù)據(jù)均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);出室時(shí)給予肌松拮抗藥患者TOF比值恢復(fù)到0.9的平均時(shí)間為(8.6±5.0)min;在復(fù)蘇室停留期間兩組患者低氧血癥(Sp O290%)的發(fā)生率為7.2%。結(jié)論:依據(jù)臨床指征判斷指導(dǎo)患者出麻醉復(fù)蘇室時(shí)肌松殘余發(fā)生率較高,肌松殘余阻滯作用可以被肌松拮抗藥物短時(shí)間內(nèi)拮抗,在復(fù)蘇室中應(yīng)用肌松監(jiān)測(cè)儀判斷出室時(shí)機(jī),指導(dǎo)患者出復(fù)蘇室有十分重要的臨床意義。
[Abstract]:Objective: to monitor the residual occurrence of muscle relaxation in anaesthesia resuscitation chamber according to clinical indications by using muscle release monitor. To explore the guiding significance of using muscle relaxation monitor in PACU for anesthesia resuscitation. Methods: select the patients with selective general anesthesia operation and transfer to anaesthesia resuscitation room after operation. The patients aged 20 to 90 years old were treated with cis-atracurium as muscle relaxant only. Tracheal catheter was removed to resuscitation chamber (extubation group). The TOF ratios of T _ (1) T _ (1), T _ (2) and T _ (3) were measured when the resuscitation room was transferred into the resuscitation chamber. The trachea catheter was retained into the resuscitation chamber (with tube group) and T4 was measured immediately after tracheal catheter was removed. The TOF ratio of T5 (30 min after extubation) and T6 (T6) after extubation were recorded. The data of the patient's demography, the use of anesthetic and muscle relaxant antagonists were recorded. Results: 306 patients were included in this study, 44 patients in the extubation group, 262 patients in the tube group, and T1 in the extubation group. The residual incidences of muscle relaxation at T2 and T3 were 61.4 and 43.2 / 15.9, respectively. The incidence of residual muscle relaxation at T _ 4, T _ 5 and T _ 6 in the tube group was 76.776% and 46.6%, respectively. 21. The time between the last application of muscle relaxant and the extubation of tracheal duct in the group with tube was less than 90 min, and the residual rate of muscle relaxation in the group with tube was higher than that in the group of 90 minutes (P 0.01). Compared with young patients (aged 20 ~ 40), the residual rate of muscle relaxation in elderly patients was higher than that in young patients (P 0.05). The average residence time of patients with TOF ratio of 0.9 to 鈮，

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