目的 探讨双套囊法监测喉内收肌诱发颤搐反应的可行性.方法 选择年龄20～50岁女性全麻择期手术患者20例.丙泊酚和舒芬太尼诱导和维持麻醉,插入双套囊气管导管,导管的测压套囊置于声门裂处.两台TOF Guard肌松监测仪同步透皮刺激喉返神经和腕部尺神经,诱发喉内收肌和拇内收肌颤搐反应.静脉注射罗库溴铵0.3 mg/kg后,观察罗库溴铵对喉内收肌与拇内收肌抑制时程和恢复过程.结果 喉内收肌的显效时间比拇内收肌快(P<0.05),起效时间亦明显比拇内收肌快(P<0.01),T1最大抑制程度明显比拇内收肌低(P<0.01).恢复过程中,喉内收肌的T1恢复到基础值的50%、75%和TOFr达0.75所需时间均明显比拇内收肌短(P<0.01),喉内收肌T1恢复到基础值90%的时间比拇内收肌明显快(P<0.05).结论 用双套囊测压法监测喉内收肌神经肌肉阻滞程度,结果稳定可靠.%Objective To investigate the feasibility of monitoring evoked twitch response of laryngeal adductor muscles by double-cuff endotracheal tube during anesthesia. Methods Twenty female patients, aged 20 to 50 years old and scheduled for selective surgical procedure, were enrolled. Anesthesia was induced and maintained with intravenous propofol and sufentanil. A double-cuff endotracheal tube was intubated, the extra cuff of which was placed between the vocal cords and the pressure changes inside the cuff were recorded. After injection of rocuronium 0.3 mg/kg, two TOF Guard monitors were used to stimulate the recurrent laryngeal nerve and the ulnar nerve with superficial electrodes simultaneously. Inhibition and recovery time of evoked twitch responses of the laryngeal adductor muscles and the adductor pollicis were recorded. Results Onset of neuromuscular blockade was faster and recovery was earlier at the laryngeal adductor muscles than those at the adductor pollicis. Lag time and onset time of laryngeal adductor muscles were shorter than those of adductor pollicis(P<0.05 or P<0.01). Maximal inhibition of laryngeal adductor muscles was lower than those of adductor pollicis(P<0.01). The times for T1 to recover to 50%, 75% and 90% baseline values and the time for TOF ratio to recover to 0.75 baseline value of the laryngeal adductor muscles were shorter than those of the adductor pollicis (P<0.05 or P<0.01). Conclusion Monitoring neuromuscular block at the laryngeal adductor muscles with the double-cuff endotracheal tube is reliable and stable.
展开▼
