米库氯铵与顺苯磺酸阿曲库铵在耳鼻喉手术中的麻醉效果及血流动力学变化比较

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摘要目的比较米库氯铵与顺苯磺酸阿曲库铵在耳鼻喉手术中的麻醉效果及血流动力学变化。方法选择2017年1月~2018年1月于保定市第二医院拟行全身麻醉下耳鼻喉手术的患者80例，按照随机数字表法随机分成观察组和对照组，每组各40例。患者入室麻醉诱导并给予肌松药，其中对照组给予顺苯磺酸阿曲库铵，观察组给予米库氯铵。记录患者入室（T1）、麻醉诱导即刻（T2）、插管（T3）、手术结束（T4）、意识恢复（T5）、拔管（T6）、出室（T7）7个时间点的平均动脉压（MAP）、心率（HR）、脉搏氧饱和度（SpO2）等血流动力学指标及脑电双频指数（BIS）值、4个成串刺激（TOF）值。记录患者恢复自主时间、睁眼时间、拔管时间、躁动及并发症发生情况。结果两组患者T1~T7不同时间点MAP、HR、SpO2值比较，差异均无统计学意义（P > 0.05）；与本组T1、T2时间点比较，对照组T5、T6、T7及观察组T7时间点的SpO2水平明显降低，差异有统计学意义（P < 0.05）。与对照组比较，观察组T4、T7两个时间点BIS值升高，T4、T5、T6、T7四个时间点TOF值升高，差异均有统计学意义（P < 0.05）；两组其他时间点的BIS及TOF值比较，差异均无统计学意义（P > 0.05）。与本组T1、T2时间点比较，对照组T4、T5、T6、T7及观察组T4、T5、T6的TOF值下降，两组T3、T4、T5时间点的BIS降低，差异有统计学意义（P < 0.05）。观察组恢复自主时间、睁眼时间、拔管时间均较对照组缩短，拔管后躁动、并发症发生率均低于对照组，差异均有统计学意义（P < 0.05）。结论米库氯铵在围术期麻醉中对患者血流动力学的影响较小，起效迅速，诱导时间短，术后肌肉收缩功能恢复快，无神经肌肉阻滞的蓄积作用，术后肌松残余者少，适合耳鼻喉手术，安全有效，值得临床上推广。

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	张晓东王惠铭齐姣尚颖温晶

关键词 ：米库氯铵, 顺苯磺酸阿曲库铵, 耳鼻喉手术, 麻醉效果, 血流动力学

Abstract：Objective To compare the anesthetic effect and hemodynamic changes of Mivacurium Chloride and Cisatracurium Besylate in ear-nose-throat surgery. Methods From January 2017 to January 2018, 80 patients with planed operation of ear, nose and throat under general anesthesia in the Second Hospital of Baoding were divided into observation group and control group according to random number table, 40 cases in each group. Patients were given muscle relaxants for general anesthesia induction, and the control group was given the Cisatracurium Besylate, the observation group was given Mivacurium Chloride. The MAP, HR, SpO2, BIS and four TOF value at seven time points of the home invasion (T1), anesthetic induction immediately (T2), intubation (T3), end of the surgery (T4), consciousness recovery (T5), tube drawing (T6), leaving the room (T7) were recorded. The time of recover, open eyes, extubation, and the restlessness and complications of patients were recorded. Results There were no significant differences in MAP, HR, and SpO2 between the two groups from T1 to T7 (P > 0.05). Compared with T1 and T2 of the same group, the levels of SpO2 in the control group at T5, T6 and the observation group at T7 decreased, and the differences were statistically significant (P < 0.05). Compared with the control group, the BIS values at T4, T7 and the TOF values at T4 to T7 were increased in the observation group, and the differences were statistically significant (P < 0.05); the BIS and TOF values of other time points between two groups were not statistically significant (P > 0.05). Compared with T1 and T2 of the same group, TOF values of T4, T5, T6, T7 in the control group and T4, T5, T6 in the observation group decreased, and the BIS of T3, T4, T5 in the two groups decreased and the differences were statistically significant (P < 0.05). The time of recovery, open eyes, extubation in observation group were shorter than those in control group, the incidence of extubation after agitation and complications was lower than those in control group, the differences were statistically significant (P < 0.05). Conclusion The effects of Mivacurium Chloride on hemodynamics perioperative anesthesia is small, work quickly, short induction time, fast recovery of muscle contraction function, and without the effect of neuromuscular blockade accumulation, it has less postoperative muscle relaxant residual, and is suitable for the ear, nose and throat surgery, safe and effective, which is worth popularizing clinically.

Key words： Mivacurium Chloride Cisatracurium Besylate Ear, nose and throat surgery Anesthetic effect Hemodynamics

基金资助:河北省保定市科技计划项目（17ZF011）。

引用本文:

张晓东王惠铭齐姣尚颖温晶. 米库氯铵与顺苯磺酸阿曲库铵在耳鼻喉手术中的麻醉效果及血流动力学变化比较[J]. 中国医药导报, 2018, 15(31): 103-106.
ZHANG Xiaodong WANG Huiming QI Jiao SHANG Ying WEN Jing. Comparison of the anesthetic effect and hemodynamic changes of Mivacurium Chloride and Cisatracurium Besylate in ear-nose-throat surgery. 中国医药导报, 2018, 15(31): 103-106.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2018/V15/I31/103

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