【摘要】：目的:比較使用不同誘導(dǎo)劑量的順式阿曲庫銨對甲狀腺癌患者術(shù)中監(jiān)測喉返神經(jīng)功能的影響。方法:擇期行喉返神經(jīng)監(jiān)測的甲狀腺癌患者1 5 0例,年齡3 0-6 0歲,A S A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)分三組,每組5 0例。麻醉誘導(dǎo):咪達(dá)唑侖0.0 3 m g/k g,丙泊酚2-3 m g/k g,芬太尼3-4μg/k g,和順式阿曲庫銨0.0 5 m g/k g(A組)、0.1 m g/k g(B組)、0.1 5 m g/k g(C組),3 m i n后且N a r c o t r e n d值4 6時經(jīng)喉鏡明視氣管插管(喉返神經(jīng)監(jiān)測導(dǎo)管)并機(jī)械通氣。術(shù)中微量泵泵入丙泊酚、瑞芬太尼和吸入七氟醚維持麻醉。記錄三組患者一般資料如性別比例、年齡、體重和手術(shù)時間;記錄插管時喉鏡暴露分級(C o r m a c h-L e h a n e,C-L)情況:Ⅰ-Ⅳ級例數(shù);記錄從給完順式阿曲庫銨到喉返神經(jīng)暴露的時間(T 1)、到第一次監(jiān)測有喉返神經(jīng)電信號的時間(T 2);記錄給完順式阿曲庫銨后4 0 m i n(T 3)、5 0 m i n(T 4)、6 0 m i n(T 5)、7 0 m i n(T 6)各時間點刺激側(cè)喉返神經(jīng)電信號的波峰值。結(jié)果:三組患者一般資料如性別比例、年齡、體重和手術(shù)時間的比較差異均無統(tǒng)計學(xué)意義(P0.0 5)。與A組相比,B組插管時C-L分級為Ⅱ級的比例明顯升高,Ⅲ級比例明顯降低,差異有統(tǒng)計學(xué)意義(P0.0 5);與A組相比,C組插管時Ⅰ級的比例明顯升高,Ⅲ級比例明顯降低,差異有統(tǒng)計學(xué)意義(P0.0 5);與B組相比,C組插管時Ⅰ級的比例明顯升高,Ⅱ級的比例明顯降低,差異有統(tǒng)計學(xué)意義(P0.0 5)。與A組相比,C組T 2時間明顯延長(P0.0 5),在T 3時無電信號,在T 4、T 5時喉返神經(jīng)電信號波峰值均顯著減小(P0.0 5);與B組相比,C組T 2時間明顯延長(P0.0 5),在T 3時無電信號,在T 4、T 5時喉返神經(jīng)電信號波峰值均顯著減小(P0.0 5);而A、B兩組的T 1、T 2值及在T 3-6各時間點電信號波峰值均接近,差異無統(tǒng)計學(xué)意義(P0.0 5)。結(jié)論:麻醉誘導(dǎo)使用劑量為0.1 m g/k g,即2倍9 5%有效劑量(9 5 p e r c e n t e f f e c t i v e d o s e,E D 9 5)的順式阿曲庫銨適宜于甲狀腺癌患者術(shù)中行喉返神經(jīng)功能的監(jiān)測。
[Abstract]:Aim: to compare the effects of different induced doses of cis-atracurium on intraoperative monitoring of recurrent laryngeal nerve function in patients with thyroid carcinoma. Methods: 150 patients with thyroid carcinoma, aged 30 to 60 years old, were randomly divided into three groups according to the different doses of cis-atracurium induction. Anesthesia induction: midazolam 0.03 mg / k g, propofol 2-3 mg / k g, fentanyl 3-4 渭 g / k g, cis atracurium 0.05 mg / k g (A) 0.1 mg / k g (B) 0.1 mg / k g (C) 3 m i n and N a r c o t r e n d 4.6 Tracheal intubation via laryngoscope (recurrent laryngeal nerve monitoring catheter) and mechanical ventilation. Intraoperative micropump infusion of propofol, remifentanil and sevoflurane maintenance anesthesia. The general data such as sex ratio, age, weight and operation time were recorded in the three groups, and the laryngoscopic exposure grade (C o r m a c h-L e h a n eosin C-L was recorded at the time of intubation: 鈪，

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