摘要
目的探究Concert-1闭环肌松注射系统输注不同剂量米库氯铵在耳鼻喉手术中的疗效及安全性差异。方法回顾分析2018年1月至2019年6月在保定市第二医院行全麻下耳鼻喉手术的病人临床资料,根据治疗剂量分为高剂量组(0.25 mg/kg)、常规剂量组(0.20 mg/kg)及低剂量组(0.15 mg/kg),各40例,并应用Concert-1闭环肌松注射系统进行对应剂量米库氯铵注射。记录两组病人肌松起效时间、恢复时间,米库氯铵注射前后血流动力学变化、血液组胺浓度变化及两组病人不良反应发生情况。结果三组病人肌松起效时间比较具有显著差异,其中高剂量组肌颤搐抑制达75%(ThD75)(135.25±15.61)s、肌颤搐抑制达90%(ThD90)(150.25±21.54)s及肌颤搐抑制达最大阻滞程度时间(ThDmax)(168.16±19.78)s均最快,低剂量组ThD75(158.71±17.24)s、ThD90(179.67±24.67)s及ThDmax(190.18±21.13)s最慢,比较差异有统计学意义(F=26.513、18.692、36.425,均P<0.001);三组病人肌松恢复时间Th R25、RI及TOFr90比较差异无统计学意义(P>0.05);米库氯铵注射后5 min,高剂量组收缩压(SBP)(113.79±23.31)mmHg出现明显降低,心率(HR)(96.47±11.97)次/分明显升高,与常规剂量组SBP(126.67±23.97)mmHg、HR(84.36±10.59)次/分和低剂量组SBP(98.72±0.84)mmHg、HR(82.49±10.54)次/分比较差异有统计学意义(F=5.818、18.804,均P<0.05);米库氯铵注射后5 min,三组病人血液组胺浓度均显著升高,其中高剂量组(1.57±0.26)ng/mL>常规剂量组(1.34±0.25)ng/mL>低剂量组(1.07±0.21)ng/mL,组间比较差异有统计学意义(P<0.05),三组米库氯铵用量、手术时间总时间及不良发应总发生率比较差异无统计学意义(P>0.05)。结论Concert-1闭环肌松注射系统输注0.20 mg/kg、0.25 mg/kg米库氯铵均能提供耳鼻喉手术中满意的肌松效果,且安全性相当,临床可根据病人机体耐受情况选择合适剂量。
Objective To explore the differences in efficacy and safety of Concert-1 closed loop muscle relaxation injection system infused with different doses of mivacurium in ear-nose-throat(ENT)surgery.Methods Clinical data of patients who underwent ENT surgery under general anesthesia in The No.2 Hospital of Baoding from January 2018 to June 2019 were retrospectively analyzed.Patients were randomly assigned into high-dose group(0.25 mg/kg),conventional dose group(0.20 mg/kg)and low-dose group(0.15 mg/kg)by random number table method,with 40 cases in each group,and the Concert-1 closed loop muscle relaxation injection system was used for the injections of corresponding doses of mivacurium.The onset time of muscle relaxation,recovery time,hemodynamic changes,changes in blood histamine concentration,and adverse reactions of the two groups of patients before and after injection were recorded.Results There was a significant difference in the onset time of muscle relaxation among the three groups.ThD75(135.25±15.61)s,ThD90(150.25±21.54)s,and ThDmax(168.16±19.78)s were the quickest in the high-dose group,and ThD75(158.71±17.24)s,ThD90(179.67±24.67)s and ThDmax(190.18±21.13)s were the slowest in the low-dose group.The differences were statistically significant(F=20.915,116.185,12.015,respectively;all P<0.001).There were no significant differences in the recovery time of ThR25,RI,and TOFr90 among the three groups(P>0.05).Five minutes after mivacurium injection,systolic blood pressure(SBP)(113.79±23.31)mmHg in the high-dose group significantly decreased,and heart rate(HR)(96.47±11.97)times/min significantly increased.In comparison with the SBP(126.67±23.97)mmHg,HR(84.36±10.59)times/min in the conventional dose group and the SBP(98.72±0.84)mmHg,HR(82.49±10.54)times/min in the low dose group,the differences were statistically significant(F=5.818,18.804;both P<0.05).Five minutes after the injection,the blood histamine concentrations of the three groups all increased significantly,which showed highest in high dose group and lowest in low dose group[(1.57±0.26)ng/mL vs.(1.34±0.25)ng/mL vs.(1.07±0.21)ng/mL].The differences among the groups were statistically significant(P<0.05).There were no statistically significant differences in the dosage of mivacurium,total operation time,and total incidence of adverse reactions among the three groups(P>0.05).Conclusions Both 0.20 mg/kg and 0.25 mg/kg mivacurium can provide satisfactory muscle relaxation in ENT surgery,and the safety is comparable.Appropriate dose can be selected clinically according to patients’body tolerance.
作者
温晶
张晓东
尚颖
WEN Jing;ZHANG Xiaodong;SHANG Ying(Department of Anesthesiology,The No.2 Hospital of Baoding,Baoding,Hebei 071000,China)
出处
《安徽医药》
CAS
2021年第10期2013-2017,共5页
Anhui Medical and Pharmaceutical Journal
基金
保定市科技支撑计划项目(17ZF011)。
关键词
米库氯铵
耳鼻喉外科手术
肌松弛
Concert-1闭环肌松注射系统
安全性
Mivacurium chloride
Otorhinolaryngologic surgical procedures
Muscle relaxation
Concert-1 closed loop muscle relaxation injection system
Safety
