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目的观察顺式阿曲库铵与琥珀胆碱在支撑喉镜检查手术中维持肌松的效果及不良反应。方法 60例择期手术成年患者(ASAⅠ～Ⅱ级),根据麻醉诱导时静注的肌松药随机分为3组(n=20):C1组顺式阿曲库铵0.15mg/kg,C2组顺式阿曲库铵0.2mg/kg,S组琥珀胆碱1.5mg/kg;其余用药一致。支撑喉镜置入前2min,S组静注琥珀胆碱0.4mg/kg,C1组和C2组根据肌松程度追加静注顺式阿曲库铵0.05mg/kg。观察项目包括:肌松程度,支撑喉镜置入条件评分,追加静注肌松剂和阿托品的次数,气管导管拔除时间,术后肌肉酸痛发生率及满意度。结果 3组患者支撑喉镜置入条件比较差别无统计学意义(P>0.05)。(1)C1组和C2组患者均无需追加肌肉松弛剂及阿托品,而S组所有患者均需追加肌松剂和阿托品,3组间比较差别有统计学意义(P<0.01)。(2)术后15min,S组患者肌力比C1组和C2组明显恢复,肌松程度与C1组和C2组比较差别有统计学意义(P<0.01)。(3)手术结束后,气管导管拔除时间C1组和C2组患者比S组延长,差别有统计学意义(P<0.05)。(4)术后24h随访,S组患者自诉躯干及四肢肌肉酸痛,舒适满意度为70%;C1组和C2组患者均无全身肌肉酸痛发生,舒适满意度为100%。S组与其他2组比较差别有统计学意义(P<0.01)。结论支撑喉镜检查手术中应用顺式阿曲库铵的肌松效果良好,舒适度高,不良反应少;但术毕拔管时间明显比琥珀胆碱延迟。
Objective To observe the efficacy and adverse reactions of cisatracurium and succinylcholine in the maintenance of muscle relaxant during laryngoscopy. Methods Sixty adult patients (ASA Ⅰ ~ Ⅱ) undergoing elective surgery were randomly divided into three groups (n = 20) according to the anesthesia group: group C1, cisatracurium 0.15 mg / kg, group C2 Cis atracurium 0.2mg / kg, S group succinylcholine 1.5mg / kg; other drugs consistent. Support laryngoscope 2min before implantation, S group intravenous succinylcholine 0.4mg / kg, C1 group and C2 group according to the degree of muscle relaxation additional intravenous cisatracurium 0.05mg / kg. Observations included: degree of muscle relaxation, placement of support laryngoscopy, addition of intravenous muscle relaxants and atropine, tracheostomy, postoperative pain and satisfaction. Results There was no significant difference in the placement conditions of the laryngoscope between the three groups (P> 0.05). (1) There was no need to add muscle relaxants and atropine to patients in group C1 and C2, and all patients in group S need to be supplemented with muscle relaxants and atropine. The difference between the three groups was statistically significant (P <0.01). (2) At 15 minutes after operation, the muscular strength of patients in group S was obviously recovered compared with that of group C1 and C2. The degree of muscle relaxation was significantly lower than that in group C1 and C2 (P <0.01). (3) After the operation, the time of tracheal catheter removal in group C1 and group C2 was longer than that in group S, the difference was statistically significant (P <0.05). (4) Follow-up 24h after operation, patients in group S complained of soreness of the trunk and limb muscles, and the satisfaction degree of comfort was 70%. There was no generalized muscle ache in C1 and C2 patients, and the satisfaction rate was 100%. The difference between S group and other two groups was statistically significant (P <0.01). Conclusions The application of cisatracurium in patients with supportive laryngoscopy showed good muscle relaxation, high comfort and few adverse reactions. However, the extubation time was significantly delayed than that of succinylcholine.