目的探讨输注不同靶控浓度顺式阿曲库铵对肥胖患者胃袖状切除手术的影响。方法选取拟全身麻醉下行腹腔镜胃袖状切除术的肥胖患者105例，随机分为3组： 持续泵注顺式阿曲库铵低靶控浓度组（1.5μg/mL，A组）、中靶控浓度组（2.0μg/mL，B组）和高靶控浓度组（2.5μg/mL，C组），每组35例。记录3组患者的年龄，体重指数，理想体重，美国麻醉医师协会分级（American Society of Anesthesiologist, ASA）分级，手术时间，睁眼时间，手术30、60min时的脑电双频指数（bispectral index, BIS）值，在四个成串刺激（train of four stimulation, TOF）达到0.25（T1）、0.75（T2）、和0.9（T3）的时间，同时记录拔除气管导管时的TOF；记录手术结束时及拔管后10min的心率（heart rate, HR）、平均动脉压（mean arterial blood pressure, MAP）；记录拔管后10min的呼吸频率、脉搏血氧饱和度（saturation of pulse oximetry, SpO2）。结果3组患者的年龄，BMI指数，理想体重，ASA分级，手术时间，手术30、60min时的BIS值，手术结束时及拔管后10min的HR、ABP，拔管后10min的呼吸频率、SpO2差异无统计学意义（P>0.05）。与A组比较，B、C两组患者睁眼时间、T1、T2、T3时间显著延长；与B组比较，C组患者睁眼时间、T1、T2、T3时间显著延长（P<0.05）。结论输注低靶控浓度肌松药用于行腹腔镜胃袖状切除术的肥胖患者，不仅缩短患者术后肌松恢复时间，且有利于肥胖患者术后快速复苏。
Effect of different target-controlled concentrations of cis-atracurium on gastric sleeve resection for obese patients
SUN Shi-yu,WANG Xing-peng,CHEN Dan,CHANG Tao,LI Cheng,ZHANG Jian-zhong,LIN Fu-qing
(Dept. of Anesthesiology, Tenth People’s Hospital， Tongji University School of Medicine， Shanghai 200072, China;Shanghai Pharmaceuticals Holding Co., Ltd., Shanghai 200020, China)
ObjectiveTo investigate the effect of different target-controlled concentrations of cis-atracurium on gastric sleeve resection in obese patients. MethodsOne hundred and five obese patients undergoing laparoscopic gastric sleeve resection under general anesthesia were randomly divided into three groups: continuous pumping low target-controlled concentration of cis-atracurium (1.5μg/mL, group A), continuous pumping medium target-controlled concentration of cis-atracurium (2.0μg/mL, group B),continuous pumping high target-controlled concentration of cis-atracurium (2.5μg/ml, group C) with 35 cases in each group. The age, BMI index, the ideal body weight, ASA classification, operation time, eye open time, bispectral index (BIS) at 30 min and 60 min after operation of the three groups were documented. During the recovery period, the time of train of four stimulation (TOF) reaching 0.25 (T1), 0.75 (T2), 0.9 (T3) was recorded; and the TOF when the tracheal tube was removed was also recorded. The heart rate (HR), mean arterial pressure (ABP) at the end of the operation and 10 min after extubation, the respiratory rate and pulse oxygen saturation (SpO2) at 10 min after extubation were observed. ResultsThere were no significant difference in age, BMI index, the ideal body weight, ASA classification, operation time, BIS at 30 min and 60 min after operation, HR and ABP at the end of operation and 10 min after extubation, respiratory rate and SpO2 at 10 min after extubation among three groups (P>0.05). Compared with group A, the time of eye open, T1, T2, T3 in group B and group C were significantly longer (P<0.05), compared with group B, the time of eye open,T1, T2, T3 in group C were significantly longer (P<0.05). ConclusionTarget-controlled infusion of low-concentration muscle relaxants can be used for obese patients undergoing laparoscopic gastric sleeve resection, which not only shortens the recovery time of postoperative muscle relaxation, but also facilitates rapid recovery of patients.