| Background and objectiveWith the continuous development of China's national economy, household income and the people's economic strength, the people at the same time on the country attached great importance to health care, expanded health insurance, therefore, accept the spleen operation to cut off flow of portal hypertension in liver cirrhosis patients is increasing. Patients with liver cirrhosis because of liver cell damage, liver lobule false generation, declining physiological function of the liver and thus make it into the body of drug metabolism, elimination and effect of changes have taken place. Patients with portal hypertension because of changes in organ function, and organ dysfunction compared to normal people, and its pharmacokinetics and pharmacodynamics have obvious differences. Therefore improve portal hypertension surgery anesthesia patient safety, reduce the perioperative incidence of complications and shorten length of stay of patients, improve satisfaction with clinical anesthesia are today one of the important issues.In modern clinical anesthesia, muscle relaxants are an important complement to general anesthesia drugs, clinical use of anesthesia during the often intermittent intravenous injection, continuous infusion or drug delivery, such as target-controlled infusion technique to maintain muscle relaxation. Application acceleration device during surgery to monitor the degree of muscle relaxation, can help doctors determine narcotic muscle relaxants additional time to restore the degree of muscle relaxation after to determine endotracheal tube pulled out after time. Cis-atracurium is a limitation of nondepolarizing muscle relaxants, atracurium are 10, one of isomers for cis-isomers. It is 80% in the human body through the body without accumulation Hoffmann elimination of metabolic wastes no muscle relaxant effect, quickly restore the current cis-atracurium has been used for clinical anesthesia, but portal hypertension in liver cirrhosis patients is still in the process of application no conclusion has been reached.The purpose of this study observed cisatracurium portal hypertension in liver cirrhosis patients for intravenous muscle relaxant effects of anesthesia, induced by tracheal intubation provided show conditions, hemodynamic changes and adverse reactions for patients in an accurate estimate of the additional muscle relaxant drugs, to determine the time after extubation, in patients with portal hypertension improve muscle relaxant drug safety and provide a reference control.Materials and methodsRandomly selected firms to be selective anesthesia of patients with portal hypertension and ASAâ…¡-â…¢22 cases (10 male, 12 female)â… group, 20 cases of early gastric cancer patients (male 10, female 10 cases)â…¡group, preoperative 30 minutes of intramuscular injection of atropine patients needle 0.5 mg and needle 0.1g luminal.Placement in all patients after admission TOF Watch SX acceleration monitoring instrument prepared muscle relaxant. Induction of anesthesia; midazolam 0.05mg/kg, etomidate 0.2-0.3mg/kg, fentanyl 2-4μg/kg, later to be sick sense of the disappearance of muscle relaxant calibration, tuningTOF first twitch response height (T1) at 100% stability in 5 minutes, 5 seconds of intravenous cis-atracurium 0.15 mg / kg, when the maximum T1 suppression of Anesthesiologists by the same skilled mechanical ventilation endotracheal intubation and to evaluate the intubation conditions. The maintenance of anesthesia with propofol 4-7 mg / kg.h, trace 0.10-0.20μg/kg.min remifentanil infusion pump, the two groups of patients T1 restore muscle relaxation to 5%,six times intermittent intravenous cis - atracurium (5s with End Note) 0.05 mg / kg. The basis of intraoperative hemodynamic changes to adjust the infusion rate of intravenous anesthetics Monitoring and evaluation indicators:(1) induced dose onset time: cis-atracurium T1 Note to decline to complete inhibition of the greatest time.(2) dose T1-induced inhibition of the extent of the largest evaluation of the conditions of tracheal intubation.(3) induced by effective doses of clinical time (since the cis-atracurium T1 Notes to restore complete 5% of the time). (4) during the six additional cis-atracurium clinical effective time (since the cis-atracurium T1 Notes to restore complete 5% of the time) clinical role at the end of time (T1 injection completion to restore to 25 % time).(5) Recovery Index: T1 Recovery from 25% to 75% of the time; T1 to restore 90% of the time; TOFR = 0.7 hours(6) Record-dose injection induced cis-atracurium instantly, 1,3,5,7,10 minutes after injection when the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean pressure (MAP) and heart rate ( HR) during anesthesia at the same time record the occurrence of adverse reactions.Statistical treatment:SAS8.1 statistical software used for statistical treatment. Measurement data to mean±standard deviation (χ±s) said that in line with the normal distribution using t test or analysis of variance, count data and rating data were used the probability of four exact and rank sum test, testing the standard of a = 0.05 as significant level. Results1. General information: gender, age, weight, height, operative time, blood loss, transfusion volume of inter-group differences were not statistically significant (P> 0.05).2. Biochemical indicators of liver function: albumin ALB, total bilirubin TBIL, clotting time, PT, alanine aminotransferase ALT, aspartate aminotransferase AST compare the two groups, the difference was statistically significant (P <0.05).3. Pharmacodynamic study3.1 induced dose onset timeâ… ,â…¡, respectively, 5.03±1.01min VS 3.99±1.23min, there is statistically significant difference (P <0.01); clinical effective time of 40.48± 4.43 min VS38.64±4.33 min with no statistical difference between the intended .3.2 Clinical effective dose of additional timeâ… ,â…¡group were: 20.37±1.92min, 20.26±2.00min, 20.59±2.02min, 20.67±1.91min, 20.81±2.21 min,21.46±2.11 min; 20.04±1.81min, 20.05±1.69 min, 20.17±2.06 min, 20.19±1.64 min, 20.27±1.64 min, 21.09±2.24 min, in I and II group , there was no statistical difference.3.3 Recovery Indexâ… ,â…¡group were 14.71±2.88min VS 13.83±2.53min, T125% recovery time of 25.05±2.29,24.60±2.04, T190% recovery time of 43.97±3.97min, 42.55±3.94min, T4/T1 = 70 % time 45.60±4.11 min VS 44.57±3.94min two groups showed no statistical significance.4. Hemodynamics4.1 Changes in heart rate: group time-point comparison between the two groups no significant difference (P> 0.05); group rate for each point in time there was no significant difference (P> 0.05).4.2 systolic blood pressure (SBP) changes: Group comparison of the two groups no significant difference between the reference time-point; group the point of comparison, no statistical significance.4.3 diastolic blood pressure (DBP) changes: Group comparison of the two groups no significant difference between the reference time-point; group comparison no significant point in time.4.4 Mean arterial pressure (MAP) changes in: the de facto comparison group was not significant, the de facto inter-group comparison was not significant.5. Tracheal intubation conditions and the situation of intraoperative muscle relaxantGroup two tracheal intubation conditions were excellent and good rate of 100 percent was not significant; T1 reach the greatest degree of 100% block.6. Narcotic adverse reactions duringThe two groups did not occur in patients with facial flushing, heart rate significantly faster, blood pressure decreased significantly, but in group II was found in Example 1 cis-atracurium induced by 3 minutes later, the chest skin red spots sparse, there is no significant change in heart rate blood pressure , returned to normal after 26 minutes.Conclusion1. 3ED95 dose of cisatracurium for portal hypertension in cirrhotic patients with satisfactory intubation conditions, but the slow onset time.2. Cisatracurium for liver cirrhosis with portal hypertension than in patients with hemodynamic stability and fewer adverse reactions.3. Cisatracurium long time, additional repeated for portal hypertension in patients with liver cirrhosis had no significant accumulation, the rapid restore. |
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