硬质支气管镜术中应用罗库溴铵行深度肌松对喷射通气氧合效果的影响

Effect of deep muscle relaxation by rocuronium on oxygenation of jet ventilation during rigid bronchoscopy procedures

摘要:

目的 探讨采用罗库溴铵实施深度肌松，在硬质支气管镜治疗术中，对喷射通气氧合效果的影响。方法 选择2021年12月－2023年2月择期行全身麻醉下经硬质支气管镜，治疗中央气道病变的患者60例，随机分为深度肌松组（D组，n = 30）和中度肌松组（M组，n = 30）。全身麻醉诱导后，插入硬质支气管镜，行喷射通气，使用罗库溴铵作为肌松剂，进行诱导和维持。M组采用4个成串刺激（TOF）测定肌松深度，维持TOF计数为1至2；D组采用强直刺激后单刺激肌颤搐计数（PTC）测定肌松深度，维持PTC在1至2。术毕，使用舒更葡糖钠拮抗残余肌松。结果 两组患者手术时间、苏醒时间和拔管时间比较，差异均无统计学意义（P > 0.05）；D组整体手术时间、手术暂停时间和麻醉时间短于M组，D组肌松剂用量大于M组，D组术中低氧血症发生次数明显少于M组，术后术者满意度高于M组，D组动脉血氧分压（PaO₂）在喷射通气15 min（T₁）和30 min（T₂）高于M组，D组术后咽喉疼痛数少于M组，差异均有统计学意义（P < 0.05）。结论 硬质支气管镜术中，应用罗库溴铵实施深度肌松，可以改善喷射通气的氧合效果，缩短手术暂停时间和麻醉时间，提高术者满意度，舒更葡糖钠拮抗残余肌松，可以解决深度肌松恢复延迟的弊端。

Abstract:

Objective To observe the effect of deep muscle relaxation by rocuronium on oxygenation of normal frequency jet ventilation during rigid bronchoscopy procedures.Methods From December 2021 to February 2023, 60 patients with central airway diseases underwent rigid bronchoscopy under general anesthesia, they were randomly divided into deep muscle relaxation group (group D, n = 30) and moderate muscle relaxation group (group M, n = 30). After induction of general anesthesia, the patients were inserted rigid bronchoscopy for jet ventilation, muscle relaxant was rocuronium in induction and maintenance. Train of four (TOF) stimulation was used to measure the depth of muscle relaxation in group M, and the TOF count was maintained at 1 or 2; In Group D, the depth of muscle relaxation was measured by post tetanic count (PTC), and the PTC was maintained at 1 or 2. After operation, Sugammadex antagonized residual muscle relaxation.Results There was no significant difference in operation time, recovery time and extubation time between the two groups (P > 0.05). The total operation time, operation pause time and anesthesia time in group D were shorter than those in group M, the dosage of muscle relaxant in group D was more than that in group M, the incidence of hypoxemia during surgery in group D was less than that in group M, the operators’ satisfaction in group D was better than that in group M, and the arterial partial pressure of oxygen (PaO₂) in group D was higher than that in group M at 15 min (T₁) and 30 min (T₂) after jet ventilation, the number of patients with postoperative sore throat in group D was less than that in group M, the differences were statistically significant (P < 0.05).Conclusion The application of deep muscle relaxation by rocuronium in rigid bronchoscopy procedures can improve the oxygenation effect of normal frequency jet ventilation, reduce the operation pause time and anesthesia time, improve the satisfaction of operators, antagonizing residual muscle relaxation with Sugammadex can relieve the worry of delayed recovery from deep muscle relaxation.