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No Repression of the Functional Recovery of Muscle and Respiration by Residual Cis-atracurium During Re-transfusion of Intraoperative Blood Salvage: A Single-center Prospective Study
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摘要:
目的 术中血液回收技术(intraoperative blood salvage，IBS)是临床常用的一种血液保护技术，但术后自体血液回输存在肌松药物残留问题。顺苯磺酸阿曲库铵(cis-atracurium besilate，Cisa)是一种新型肌松药物，本研究观察Cisa应用于接受IBS患者的临床安全性。 方法 前瞻性分析比较2017年3月至6月在北京积水潭医院脊柱科接受全身麻醉下腰椎减压内固定手术的50例腰椎间盘突出患者。患者顺序纳入，前25例进入试验组，后25例进入对照组。全身麻醉后应用Cisa作为肌松药，采用IBS技术于术中采集手术视野自体血并洗涤。术后入恢复室，常规监测4个成串刺激(train-of-four stimulation，TOF)以评估肌肉恢复情况，拔除气管插管后每隔5 min记录TOF值，共观察40 min。试验组患者于拔除气管插管后一次性输入术中收集的自体血，对照组于40 min观察结束后回输自体血。分析并比较两组患者术前及观察结束时的动脉血氧分压(arterial partial pressure of oxygen，PaO2)和二氧化碳分压(partial pressure of carbon dioxide in artery，PaCO2)，用于评估呼吸功能恢复情况。 结果 所有患者完成全部观察内容，其中男女比例1:1，年龄(55.1±11.1)岁，体重(72.7±9.8)kg，两组基线资料均衡，TOF值随时间推迟呈上升趋势，但两组患者在40 min观察点上TOF增加值无统计学差异[(9.6±7.3)%比(9.5±8.1)%，P=0.963]。两组患者在观察结束时均出现一定程度的呼吸功能不全，但组间PaCO2-incr[4.4 (2.0, 8.0)mm Hg比4.8 (0, 7.1)mm Hg，P=0.312)(1 mm Hg=0.133 kPa)和PaO2-decr[3.2 (-2.4, 7.9)mm Hg比7.2(-1.6, 13.0)mm Hg, P=0.133]并无统计学差异。 结论 全身麻醉下接受IBS的患者使用Cisa作为肌松药物是安全的。 Abstract:Objective Intraoperative blood salvage (IBS) is a commonly used technique of blood protection in the clinic. However, salvaged blood may contain muscle relaxant and lead to repression of the functional recovery of muscle and respiratory after surgery. Cis-atracurium besilate (Cisa) is a new type of muscle relaxant. The aim of this study was to investigate the safety of Cisa in patients receiving IBS. Methods Fifty patients with lumbar disc herniation who received lumbar decompression and internal fixation under general anesthesia in the Department of Spine, Beijing Jishuitan Hospital from March to June 2017 were prospectively and sequentially enrolled. The first 25 patients were included in the experimental group and the last 25 in the control group. Cisa was used as the muscle relaxant during general anesthesia. In both groups, the IBS technique was used to collect and wash the autologous blood from the surgical field. In the post anesthesia care unit, train-of-four stimulation (TOF) was monitored every 5 min for 40 min after extubation to evaluate the recovery of muscle function. The salvaged blood was one-timely re-transfused after extubation in the experimental group and 40 min later in the control group. The arterial partial pressure of oxygen (PaO2) and the partial pressure of carbon dioxide in the artery (PaCO2) were assessed before anesthesia and immediately after observation to evaluate the respiratory function. Results All patients in both groups finished the whole observation. There were 25 men and 25 women with average age of (55.1±11.1)years and weight of (72.7±9.8)kg. The basic data between two groups were matched. An upward trend of TOF was shown with time, while the increase of TOF at the 40-min point showed no statistical difference between the two groups [(9.6±7.3)% vs. (9.5±8.1)%, P=0.963]. Patients in both groups underwent respiratory insufficiency by the end of observation, but there was no statistical difference in PaCO2-incr[4.4(2.0, 8.0)mm Hg vs. 4.8(0, 7.1)mm Hg, P=0.312](1 mm Hg=0.133 kPa) and PaO2-decr[3.2(-2.4, 7.9)mm Hg vs. 7.2(-1.6, 13.0)mm Hg, P=0.133] between groups. Conclusion Cisa is safe as a muscle relaxant for patients receiving IBS under general anesthesia. 利益冲突 无 -
表 1 试验组与对照组患者一般情况比较(x ±s)
参数 试验组(n=25) 对照组(n=25) P值 年龄(岁) 56.2±7.1 54.0±14.0 0.496 体重(kg) 71.5±11.1 74.0±8.3 0.375 手术时间(min) 126.0±40.2 121.8±36.1 0.699 出血量(ml) 476.0±136.3 500.0±170.0 0.585 芬太尼用量(μg/kg) 3.39±2.59 3.23±2.26 0.782 
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表 2 试验组与对照组麻醉前及术后肌肉功能监测结束时的PaO2及PaCO2比较(mm Hg)
组别 PaO2 PaCO2 PaO2-before(x±s) PaO2-after(x±s) PaO2-decr[M(Q)] PaCO2-before(x±s) PaCO2-after(x±s) PaCO2-incr[M(Q)] 对照组(n=25) 85.5±6.8 78.4±9.0 7.2(-1.6, 13.0) 39.1±4.1 43.3±3.8 4.8(0, 7.1) 试验组(n=25) 85.5±8.3 82.5±7.0 3.2(-2.4, 7.9) 38.6±2.7 43.9±3.4 4.4(2.0, 8.0) P值 0.999 0.097 0.133 0.637 0.581 0.312 PaO2-before：术前动脉血氧分压；PaO2-after：术后肌肉功能监测结束时动脉血氧分压；PaO2-decr：PaO2-before-PaO2-after；PaCO2-before：术前动脉血二氧化碳分压；PaCO2-after：术后肌肉功能监测结束时动脉血二氧化碳分压; PaCO2-incr：PaCO2-after-PaCO2-before
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