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目的:观察持续输注米库氯铵在老年患者麻醉恢复期的肌松残余作用,探讨其与血浆假性胆碱酯酶活性的相关性。方法:选择拟行择期腹腔镜下胃肠肿瘤切除手术的老年患者48例,ASAI-II级,随机分成持续输注米库氯铵组(M组)和持续输注顺苯磺酸阿曲库铵组(C组),每组24例。采用4个成串刺激尺神经,通过拇内收肌的收缩反应以监测TOFR值(T4/T1)。记录两组患者围拔管期血流动力学变化、脑电双频指数(BIS)、神经肌肉功能的恢复及术后不良反应等。M组在麻醉诱导前和拔管时分别采集动脉血并检测血浆假性胆碱酯酶活性(D1和D2)。结果:两组患者年龄、身高、体重、BMI、手术时间、失血量、术毕体温、输液量以及D1和D2的比较,差异无统计学意义(P>0.05)。两组D1与D2的差值D与输液量明显相关,具有统计学意义(r=0.425,P<0.05);M组的临床时效、恢复指数、TOFR恢复到0.7的时间、TOFR从0.7恢复到0.9的时间和停药至拔管时间均明显小于C组(P<0.05);血浆假性胆碱酯酶活性(D1和D2)分别与临床指数、恢复指数、TOFR恢复到0.7的时间、TOFR从0.7恢复到0.9的时间、停药至拔管时间相关性不大(P>0.05),M组肌松残余发生率相对低(P<0.05)。结论:在老年患者全身麻醉手术的围拔管期,米库氯铵的肌松恢复时间短于顺式阿曲库铵,肌松残余作用相对较少,并与血浆假性胆碱酯酶活性有相关性。
OBJECTIVE: To observe the residual muscle relaxant effect of sustained infusion of beccuronium chloride in elderly patients during recovery from anesthesia and to explore its correlation with plasma pseudo-cholinesterase activity. Methods: Forty-eight elderly ASAI-II patients undergoing laparoscopic resection of gastrointestinal tumors undergoing elective laparoscopic surgery were randomly divided into continuous infusion of mikkolimus (M group) and continuous infusion of atracurium Ammonium group (C group), 24 cases in each group. Four bunches were used to stimulate the ulnar nerve, and the TOFR value (T4 / T1) was monitored by the contraction response of the adductor adductor muscle. The changes of peri-catheter hemodynamics, the bispectral index (BIS), the recovery of neuromuscular function and postoperative adverse reactions were recorded. Group M received arterial blood before and during extubation and measured plasma Pseudomonas cholinesterase activity (D1 and D2). Results: There was no significant difference in age, height, weight, BMI, operation time, blood loss, body temperature, infusion volume and D1 and D2 between the two groups (P> 0.05). The difference of D1 and D2 between the two groups was significantly correlated with the infusion volume (r = 0.425, P <0.05). The clinical aging and recovery index of M group were restored to 0.7 after TOFR. The TOFR was restored from 0.7 to (P <0.05). The plasma pseudo-cholinesterase activities (D1 and D2) were correlated with clinical indexes, recovery index, TOFR recovery time to 0.7, TOFR From 0.7 to 0.9, there was no significant correlation between withdrawal time and extubation time (P> 0.05). The incidence of muscle relaxants in M group was relatively lower (P <0.05). Conclusion: During the period of peri-extubation of general anesthesia in elderly patients, the recovery time of muscimol is shorter than that of cisatracurium, and the remnant effect of muscle relaxant is relatively small. Compared with the plasma pseudo-cholinesterase activity Relevant.