闭环肌松注射系统反馈调节苯磺顺阿曲库铵用药的精确性研究

摘要

Objective To investigate feedback regulation of close-loop muscle relaxant injection system on accuracy of cisatracurium besilate usage. Methods Two hundred patients undergoing laparoscopic cholecystectomy surgery, aged 20 to 40 years old, at ASA Ⅰ or Ⅱ, were randomly divided into two groups:control group and treatment group (n=100 each group).In the control group, the patients received injection of cisatracurium besilate with closed-loop muscle relaxant injection system at 1.5-2.0 μg·kg-1 ·min-1 , until 30 min before the end of surgery;if the muscle relaxant level could not meet the requirement of the operation, extra 0.05 mg·kg-1 was added.The treatment group was adopted closed-loop muscle relaxant monitoring under negative feedback regulation of infusion cisatracurium, and the close-loop control parameters were set to: drug was added when TOF was 8%, and injection speed was 2. 5 μg · kg-1 · min-1 , maintaining speed was 0. 33 μg · kg-1 · min-1 , the stimulus current for monitoring muscle relaxant was 60 mA , and the pulse width was 200μs.The Cooper score, cisatracurium dosage, and muscle recovery index, TOFr75 and TOFr90 of the two groups were compared. Prediction probability ( Pk ) of NI on awakening period of eye opening and directional force recovery of the two groups were detected, and regression equation was established to predict ED50 and ED95 related NI . Results Cooper score was significantly higher in the treatment group than in the control group ( P0.05) . Conclusion The accuracy of closed loop muscle relaxant injection system is higher than that of the traditional method, it provides better muscle relaxation effect for tracheal intubation, reduces recovery time, increases the Pk of NI on patient awakening.%目的 观察闭环肌松注射系统反馈调节苯磺顺阿曲库铵用药的精确性. 方法 选择拟行腹腔镜下胆囊切除手术患者200例(年龄20~40岁,ASAⅠ或Ⅱ级) ,采用随机数字表法分为两组. 对照组( n=100)持续输注苯磺顺阿曲库铵1.5~2.0 μg·kg-1·min-1,直至手术结束前30 min,若肌松不能满足手术要求则追加0.05 mg·kg-1. 治疗组(n=100)采用闭环肌松监测下负反馈调控输注苯磺顺阿曲库铵,闭环控制参数设置为:增药条件为4个成串刺激肌松监测(TOF)恢复至8%,增药速度2.5 μg·kg-1·min-1,维持速度0.33 μg·kg-1·min-1,肌松监测刺激电流60 mA,脉冲宽度200 μs. 记录对比两组Cooper评分、苯磺顺阿曲库铵用量及肌力达恢复指数、TOFr75、TOFr90的时间,检测两组意识深度指数( NI)对苏醒期呼之睁眼以及定向力恢复的预测概率( Pk ) ,建立回归方程并预测半数有效剂量( ED50 )、95%有效剂量(ED95)对应的NI. 结果 治疗组肌松效果评分显著高于对照组(P0.05). 结论 闭环肌松注射系统反馈苯磺顺阿曲库铵用药较传统方法的精确性高,为气管插管提供了更好的肌松效果,减少苏醒时间,增加NI对患者苏醒的Pk.