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目的探讨靶控输注(TCI)维库溴胺在口腔颌面外科手术中的应用。方法择期手术患者60例,随机分为维库溴铵靶控输注(TCI)(Ⅰ组)和常速输注(Ⅱ组),每组30例。静脉推注咪唑安定、芬太尼、丙泊酚后,Ⅰ组维库溴铵起始血浆靶控浓度0.14μg/ml;Ⅱ组0.1 mg/kg静脉推注维库溴铵。气管插管后,Ⅰ组维库溴铵继续TCI输注,调整靶浓度每次增加0.01μg/ml,直至T1消失。Ⅱ组50μg.kg-1.h-1静脉持续泵入,调整泵速至T1消失。临近手术结束时停用维库溴铵,术毕不用肌松拮抗药。记录肌松起效时间、维库溴铵用量和肌张力恢复时间。结果Ⅰ组肌松起效时间(291.07±28.48)s,显著长于Ⅱ组的(244.87±26.03)s(P<0.01);Ⅰ组维库溴铵平均用药量(57.47±4.77)μg.kg-1.h-1,明显少于Ⅱ组的(80.30±8.08)μg.kg-1.h-1(P<0.01);Ⅰ组肌张力恢复时间(16.85±1.94)min,明显短于Ⅱ组的(21.00±1.48)min(P<0.01)。结论与常速输注方法比较,维库溴铵TCI能减少药物用量,利于肌张力恢复,更适用于长时间手术。
Objective To investigate the application of target controlled infusion (TCI) vecuronium in oral and maxillofacial surgery. Methods Sixty patients undergoing elective surgery were randomly divided into two groups: target controlled infusion of vecuronium (group Ⅰ) and group Ⅱ (n = 30). Intravenous injection of midazolam, fentanyl, propofol, the first group of Vecuronium starting plasma target control concentration of 0.14μg / ml; Ⅱ 0.1mg / kg intravenous vecuronium. After intratracheal intratracheal intratracheal instillation of vecuronium in group I continued with TCI infusion, and the target concentration was increased by 0.01 μg / ml each time until T1 disappeared. Group Ⅱ 50μg.kg-1.h-1 pumped continuously, adjust the pump speed to T1 disappear. Vecuronium bromide is discontinued near the end of surgery, and muscle relaxant antagonists are not used at the end of surgery. Record muscle relaxant time, vecuronium dosage and muscle tone recovery time. Results The onset time of muscle relaxant in group Ⅰ was significantly longer than that in group Ⅱ (291.07 ± 28.48) s (244.87 ± 26.03) s (P <0.01). The mean dose of vecuronium in group Ⅰ was 57.47 ± 4.77 μg · kg- 1.h-1 was significantly less than that of group Ⅱ (80.30 ± 8.08) μg.kg-1.h-1 (P <0.01); The duration of muscle tone recovery in group Ⅰ was (16.85 ± 1.94) min, which was significantly shorter than that in group Ⅱ (21.00 ± 1.48) min (P <0.01). Conclusion Compared with the regular infusion method, vecuronium TCI can reduce the amount of drugs, which is conducive to muscle tension recovery, more suitable for long-term surgery.