本文選題：順式阿曲庫銨　切入點：老年人　出處：《廣東醫(yī)學(xué)》2017年14期

【摘要】：目的比較不同誘導(dǎo)劑量的順式阿曲庫銨對老年甲狀腺癌患者術(shù)中監(jiān)測喉返神經(jīng)功能的影響。方法選擇擇期行喉返神經(jīng)監(jiān)測的老年甲狀腺癌患者150例,年齡60~75歲,ASA分級Ⅰ~Ⅱ級,根據(jù)順式阿曲庫銨誘導(dǎo)劑量的不同隨機(jī)分3組,每組50例。麻醉誘導(dǎo):咪達(dá)唑侖0.03 mg/kg,丙泊酚2 mg/kg,芬太尼4μg/kg,以及順式阿曲庫銨0.05 mg/kg(A組)、0.1 mg/kg(B組)、0.15 mg/kg(C組),3 min后且Narcotrend值46時插管(喉返神經(jīng)監(jiān)測管)并機(jī)械通氣。術(shù)中泵入丙泊酚、瑞芬太尼和吸入七氟醚維持麻醉。記錄3組患者插管前30 s及插管后30 s的收縮壓(SBP)、舒張壓(DBP)及心率(HR);記錄插管時喉鏡暴露Cormach-Lehane(C-L)分級情況(Ⅰ~Ⅳ級例數(shù));觀察并記錄插管時嗆咳反應(yīng);記錄從給完順式阿曲庫銨到喉返神經(jīng)暴露的時間(T1)、到第1次監(jiān)測到電信號的時間(T2);記錄給完順式阿曲庫銨后40 min(T3)、50 min(T4)、60 min(T5)、70 min(T6)各時間點刺激側(cè)電信號的波峰值。結(jié)果與插管前30 s相比,3組患者在插管后30 s的SBP、DBP及HR顯著升高(P0.05);與A組相比,B、C兩組在插管后30 s的SBP、DBP及HR顯著降低(P0.05),插管時C-L分級為Ⅰ級的比例明顯升高(P0.05),Ⅱ級的比例明顯降低(P0.05),插管時嗆咳反應(yīng)發(fā)生率顯著降低(P0.05),C組T2時間明顯延長(P0.05),在T3時無電信號,在T4、T5時電信號波峰值顯著減小(P0.05);B組在T3~T6各時間點電信號波峰值均與A組接近,差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論麻醉誘導(dǎo)使用劑量為0.1 mg/kg(即2倍ED95)的順式阿曲庫銨適宜于老年甲狀腺癌患者術(shù)中行喉返神經(jīng)功能的監(jiān)測。
[Abstract]:Objective to compare the effects of different induced doses of cis-atracurium on intraoperative monitoring of recurrent laryngeal nerve function in elderly patients with thyroid carcinoma.Methods 150 elderly patients with thyroid cancer, aged 6075 years, who underwent recurrent laryngeal nerve monitoring (RLN) were randomly divided into 3 groups (50 cases in each group) according to the different doses of cis-atracurium.Anesthesia induction: midazolam 0.03 mg / kg, propofol 2 mg / kg, fentanyl 4 渭 g / kg, and cis atracurium 0. 1 mg/kg(B group were intubated with Narcotrend value 46 min after 0. 15 mg/kg(C group (recurrent laryngeal nerve monitoring tube) and mechanical ventilation.Anesthesia was maintained by pumping propofol, remifentanil and sevoflurane during the operation.Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HRV) were recorded 30 seconds before intubation and 30 hours after intubation, and the classification of Cormach-Lehane C-L (鈪，

本文編號：1729419