[靶控输注顺式苯磺酸阿曲库铵在腹腔镜胆囊切除手术中的麻醉效果]苯磺酸顺式阿曲库铵
[摘要] 目的 探讨靶控输注顺式苯磺酸阿曲库铵在腹腔镜胆囊切除手术中的临床麻醉效果。 方法 选择行腹腔镜胆囊切除术的患者52例，均按美国麻醉师协会分级（ASA）Ⅰ～Ⅱ级，采用全凭静脉麻醉，患者意识丧失后给予靶控输注顺式苯磺酸阿曲库铵，并观察其肌肉松弛效果、血流动力学的变化、气管插管情况。 结果 所有患者在抑制达到100%时，完成气管插管；术中血流动力学稳定，所有患者未见皮肤潮红和支气管痉挛的症状。 结论 靶控输注顺式苯磺酸阿曲库铵在腹腔镜胆囊切除手术中，不但可以提供满意的插管条件，肌肉松弛恢复时间也快，且对血流动力学无明显的影响。
[关键词] 腹腔镜胆囊切除手术；顺式苯磺酸阿曲库铵；靶控输注
[中图分类号] R619 [文献标识码] A [文章编号] 1673-7210（2012）07（c）-0092-02
Anesthesia effects of the syn-form atracurii besilas by target controlled infusion on laparoscopic cholecystectomy
ZHOU Guantong WEN Qingxian CHEN Xinmei LI Jinbo LI Yinmei
Department of Anesthesiology, the People"s Hospital of Yingde City, Guangdong Province, Yingde 513000, China
[Abstract] Objective To discuss the anesthesia effects of the syn-form atracurii besilas by target controlled infusion on laparoscopic cholecystectomy. Methods 52 patients undergoing elective laparoscopic cholecystectomy were chosen, and all were graded for Ⅰ to Ⅱ grade according to the American Association of Anesthetists (ASA), using the total intravenous anesthesia, when all the patients had no consciousness, and began to use the target controlled infusion to the syn-form atracurii besilas, the effects of the muscular relaxation, the change of the hemodynamics, trachea cannula circs were observed. Results When all the patients were bated to achieve 100%, and then finished the trachea cannula, the change of the hemodynamics was stabilization, no patients had the erubescence and bronchial spasm was no change. Conclusion In laparoscopic cholecystectomy, the syn-form atracurii besilas by target controlled infusion can afford the satisfactory trachea cannula condition. The comeback of the muscular relaxation is rapidness, and no influence on the hemodynamics.
[Key words] Laparoscopic cholecystectomy; Syn-form atracurii besilas; Target controlled infusion
因腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）手术时间短、患者创伤小、操作简便、周转快，所以对麻醉的要求是快速诱导、维持期平稳、苏醒快。靶控输注（target-controlled infusion，TCI）是以药物动力学为基础，以血浆或效应室的药物浓度为指标，通过计算机程序控制药物输注按临床需要调节麻醉深度，具有给药迅速、精确和方便等特点[1]。TCI具有抑制应激、维持血流动力学稳定、诱导平稳、苏醒快的优点[2]。顺苯磺酸阿曲库铵为一种中时效非去极化肌肉松弛药，属于阿曲库铵10种同分异构体中的之一，不但对肌肉松弛有较好的作用，而且起效时间快，没有组胺的释放，不影响血流动力学，也没有蓄积[3]。本文旨在通过观察TCI顺式苯磺酸阿曲库铵在LC中的肌肉松弛效果、血流动力学的影响，为该肌肉松弛药的临床研究和应用提供参考。
1 资料与方法
1.1 一般资料
选择2009年8月～2010年8月期间行腹腔镜胆囊切除术的患者52例（ASA Ⅰ～Ⅱ级），其中，男33例，女19例；年龄18～64岁，平均（52.7±10.1）岁；体重46～70 kg，平均（44.2±14.8）kg；既往无心肝肾功能异常，无神经肌肉传导功能疾病，无内分泌疾病；术前无水电解质平衡紊乱；亦未用已知可影响神经肌肉传导功能的药物及组胺受体激动剂或拮抗剂。对本药物过敏者、孕妇、怀疑困难气道者、体重指数小于18 kg的患者不纳入本研究。