心脏病人行非心脏手术麻醉恢复期肌松拮抗剂使用安全性评估

Safety of muscle relaxant antagonism for patients with heart disease and non-heart operation during post-anesthesia recovery period

摘要:

目的：研究探讨心脏病人接受全身麻醉下的非心脏手术后在麻醉恢复室（postanesthesia care unit，PACU）内使用新斯的明拮抗维库溴铵的有效性及安全性。方法：随机选择180例符合美国麻醉医师协会（American Society of Anesthesiologists，ASA）制定的分级标准ASAⅡ～Ⅲ级、年龄19～65岁、既往合并高血压性心脏病、冠心病、风湿性心脏病、肺源性心脏病，择期接受全身麻醉下行非心脏手术的患者。手术结束进入PACU后随机分为3组，对照组（C组）在麻醉恢复期不使用任何肌松拮抗药待患者自然苏醒；新斯的明单次给药组（N组）当４次成串刺激（train of four，TOF）恢复达25%时，静脉注射新斯的明40 μg/kg和阿托品20 μg/kg；新斯的明分次给药组（M组）分别于TOF值达25%及75%时，静脉注射新斯的明20 μg/kg及阿托品10 μg/kg。监测各项生命体征，分别记录3组从TOF值25%到90%时的拔管时间和Aldrete评分达到9分送出PACU的时间及该期间的低血压、高血压、心律紊乱、动脉血气分析、再插管情况、恶心呕吐及谵妄发生情况。结果：与C组相比，N组及M组拔管时间明显缩短（P<0.01），各组并发症发生率无明显差别。结论：心脏病人行非心脏手术在PACU合理应用肌松拮抗剂能促进肌肉收缩功能恢复，缩短全麻患者拔管时间，无不良事件发生，是安全可行的。

Abstract:

Objective：To study the efficacy and safety of using neostigmine antagonism vecuronium bromide for patients with heart disease undergoing non-heart operation under general anesthesia in post-anesthesia recovery room（PACU）. Methods：Totally 180 pa－tients of American Society of Anesthesiologists（ASA）Ⅱ-Ⅲ level，19-65 year-old，complicated with hypertensive cardiopathy，coronary heart disease，rheumatic heart disease and pulmonary heart disease，undergoing non-heart operation under general anesthesia were randomly selected. After entering PACU，patients were randomly divided into 3 groups：control group（C group），using no muscle loose antagonistic drugs during anesthesia recovery period until recovery，neostigmine single medication group（N group） intravenous injec－tion of neostigmine 40 μg and atropine 20 μg when train of four（TOF） reaching 25%，neostigmine twice to medicine group（M group），intravenous injection of neostigmine 20 μg/kg and atropine 10 μg/kg when TOF reaching 25% and 75% respectively. Vital signs were monitored in three groups. Extubation time from TOF 25% to 90% and PACU discharging time when Aldrete score reaching 9 were recoded. Hypotension，hypertension，cardiac arrhythmia，arterial blood gas analysis，reintubation rate，incidence of nausea and vomiting and delirium were recorded in three groups during the periods mentioned above. Results：Extubation time was significantly shortened in N and M groups than in group C（P<0.01） without significant differences in complication rate between groups. Conclusions：Rea－sonable application of muscle relaxant antagonism for patients with heart disease undergoing non-heart operation in PACU can pro－mote muscle contraction function recovery，shorter extubation time under general anesthesia without inducing adverse events，therefore is safe and feasible.