二氧化碳气腹对腹腔镜手术中罗库溴铵肌松效应的影响

Effect of carbon dioxide pneumoperitoneum on neuromuscular blockade of rocuronium in patients undergoing laparoscopic surgery

摘要:

目的：探讨二氧化碳气腹对腹腔镜手术中罗库溴铵肌松效应的影响。方法：选择拟在全身麻醉下行择期腹腔镜下全子宫切除术或开腹全子宫切除术患者各30例，所有患者麻醉方案相同，采用TOF-Watch SX肌松监测仪行神经肌肉传导功能监测。麻醉诱导插管后，待T1颤搐高度（T1）与对照值（Tc）的比值（T1/Tc）恢复至10%后开始持续输注罗库溴铵，术中根据T1/Tc调整输注速率，维持 T1/Tc在0％～10%。记录停用肌松药后 T1/Tc恢复至25%的时间（T1/Tc25%）、恢复指数（T1/Tc从25%恢复至75%的时间），４个成串刺激（train of four，TOF）比值（T4/T1）恢复至90%的时间（TOF90%），计算单位时间罗库溴铵使用量。结果：2组患者一般资料无差异。与开腹手术组相比，停止输注罗库溴铵后，腹腔镜手术组 T1/Tc 25%和恢复指数明显延长，TOF90%也较长（P<0.01）。腹腔镜手术组术中单位时间肌松药使用量小于开腹手术组（P=0.001）。结论：CO2气腹可能引起腹腔镜手术患者对罗库溴铵的代谢能力降低，从而使肌松效应维持时间延长，恢复缓慢，实施该类手术的麻醉时应加强肌松监测，适度减少用药量。

Abstract:

Objective：To evaluate the effect of carbon dioxide pneumoperitoneum on neuromuscular blockade of rocuronium in patients undergoing laparoscopic surgery. Methods：Sixty patients sche-duled for either laparoscopic or open hysterectomy procedures under general anesthesia were enrolled，30 patients in each group. The same anesthetic protocol was performed to all pa－tients. The responses of adductor pollicis to train of four（TOF） stimulation of ulnar nerve were monitored. After intubation，each patient received rocuronium by continuous infusion with initial rate of 6 μg/（kg?min） to maintain the ratio of T1 and Tc（T1/Tc） at the level between 0% and 10%. The time interval from the end of rocuronium infusion to 25% recovery of T1/Tc（T1/Tc 25%），recovery in－dex（T1/Tc from 25% to 75%），the duration of TOF from 0％ to 90%（TOF90%），dosages of rocuronium administered during anesthesia maintenance were recorded. Results：The demographic data including age，weight，height，body mass index（BMI），surgical time，dura－tion of rocuronium infusion were comparable between the groups. T1/Tc 25%，recovery index and TOF90% were significantly longer in patients underwent laparoscopic hysterectomy than in those underwent open hysterectomy（P<0.01）. The amount of rocuronium used anesthesia maintenance was less in laparoscopic group than in open group（P=0.001）. Conclusion：Carbon dioxide pneumoperitoneum appears to slow down the metabolism of recoronium，which may result in prolonged duration of action，as well as delayed recovery after muscle relaxant administration in laparoscopic surgery.