腰椎手术中椎旁肌不同脂肪浸润程度对罗库溴铵使用剂量及效果的影响

doi:10.3760/cma.j.cn101202-20221126-00378

摘要
图/表
参考文献
相关文章 (2)

全文: PDF (928 KB) HTML (2 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨在腰椎手术中,椎旁肌不同程度的脂肪浸润对罗库溴铵使用剂量及效果的影响。方法前瞻性队列研究。纳入2021年12月—2022年9月山西医科大学第二医院择期行经L_4~5节段椎管减压+椎体融合手术患者87例,其中男42例、女45例,年龄31~65岁。美国麻醉协会Ⅰ级22例、Ⅱ级65例。87例患者术前行MR检查,测量L_4~5节段手术区域的椎旁肌（包括脊肌、多裂肌）的横截面积（CSA）、功能性肌肉面积（FMA）、脂肪浸润率。按照患者的脂肪浸润率将87例患者分为3组：脂肪浸润率<30%的28例为轻度脂肪浸润组（L组）,脂肪浸润率30%~50%的30例为中度脂肪浸润组（M组）,脂肪浸润率>50%的29例为重度脂肪浸润组（H组）。术中采用Drager Trident肌松监测仪监测斜方肌的肌肉松弛情况;术中麻醉维持期间罗库溴铵连续泵注,根据强直刺激后计数（PTC）调整罗库溴铵泵速（维持0<PTC≤2）,并根据术中肌肉松弛状态间断给予罗库溴铵5 mg。观察指标：（1）比较3组患者临床基线资料;（2）比较3组患者腰椎L_4~5节段椎旁肌CSA、FMA;（3）比较3组患者麻醉维持期间罗库溴铵的用药总量、泵注时间、泵速,罗库溴铵起效时间、临床时效、恢复指数,以及术中肌松满意度评分。结果（1）3组患者性别、年龄、身高、体质量、体质量指数（BMI）、去脂体质量、术前白蛋白与电解质等临床基线资料比较,差异均无统计学意义（P值均>0.05）。（2）3组患者腰椎L_4~5椎旁肌CSA差异无统计学意义（P>0.05）,FMA由大到小为L组（35.8±4.4）cm²、M组（29.3±6.7）cm²、H组（19.9±3.1）cm²,差异有统计学意义（F=73.22,P<0.001）。（3）麻醉维持期间罗库溴铵的用药总量由高到低为L组（42.1±5.0）mg、M组（30.5±8.1）mg、H组（25.5±5.4）mg,泵速由高到低为L组（23.7±2.8）μg·kg^-1·min^-1、M组（18.1±2.6）μg·kg^-1·min^-1、H组（16.42±2.3）μg·kg^-1·min^-1,起效时间由长到短为L组（108.4±8.6）s、M组（102.8±10.2）s、H组（96.9±8.2）s,临床时效由长到短为H组（31.0±3.1）min、M组（27.0±3.2）min、L组（24.0±2.6）,差异均有统计学意义（F=51.05、60.54、11.45、40.76, P值均<0.001）;而3组患者罗库溴铵的泵注时间、恢复指数及术中肌松的满意度评分差异均无统计学意义（P值均>0.05）。结论在腰椎手术中,患者手术区域椎旁肌的脂肪浸润程度越低,罗库溴铵的用量越大、起效时间越长、临床时效越短;椎旁肌的脂肪浸润程度可为患者在腰椎手术中罗库溴铵的个体化用药提供参考。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	李晶
	岳维
	赵伟
	张林忠
	王静
	朱修锦

关键词 ：神经肌肉阻滞, 脂肪浸润, 罗库溴铵, 肌松监测, 脊柱手术

Abstract：Objective This study aimed to investigate the effect of different degrees of fat infiltration of paravertebral muscles on the use of rocuronium in lumbar surgery. Methods This study was a prospective cohort study. From December 2021 to September 2022, 87 patients who underwent L_4-5 spinal canal decompression combined with vertebral fusion surgery were selected in the Second Hospital of Shanxi Medical University, including 42 males and 45 females aged 31-65 years. The American Association of Anesthesiology classified 22 cases as grade Ⅰ and 65 cases as grade Ⅱ. All patients underwent preoperative MR examination to measure the cross sectional area (CSA), functional muscle area (FMA), and fat infiltration rate of the spine muscle and multifidus muscle (collectively referred to as paravertebral muscle) in the L_4-5 segment of the surgical area. They were divided into three groups in accordance with the fat infiltration rate, Among them, 28, 30, and 29 patients with fat infiltration rates <30%, ≥30%-50%, and >50% were categorized into mild fat infiltration group (L group), moderate fat infiltration group (M group), and severe fat infiltration group (H group), respectively. The Drager Trident muscle relaxation monitor was used to monitor the muscle relaxation of trapezius muscle. During the maintenance of anesthesia, rocuronium was continuously pumped. The pump speed of rocuronium was adjusted in accordance with the post-tetanic stimulation count (PTC) to maintain 0<PTC≤2; 5 mg of rocuronium was given intermittently on the basis of the muscle relaxation state during operation. For observational indicators, (1) the clinical baseline data of the three groups of patients were compared; (2) the CSA and FMA of lumbar paravertebral muscles at L_4~5 of the three groups were compared; and (3) the total dosage of rocuronium, the pump time, the pump speed, the onset time of rocuronium, the clinical efficacy, the recovery index, and the satisfaction score of intraoperative muscle relaxation among the three groups were compared. Results (1) No statistically significant difference was found in the clinical baseline data of gender, age, height, body mass, body mass index, degreased body mass, preoperative albumin, and electrolyte among the three groups (all P values >0.05). (2) No statistically significant difference was observed in the CSA of lumbar L_4-5 paravertebral muscles among the three groups (P >0.05). The FMA was, from large to small, in the following order: L group (35.8±4.4)cm², M group (29.3±6.7)cm², H group (19.9±3.1)cm². The difference was statistically significant (F=73.22, P<0.001). (3) During the maintenance of anesthesia, the total amount of rocuronium was, from high to low, as follows: L group (42.1±5.0)mg, M group (30.5±8.1) mg, H group (25.5±5.4) mg. The pump speed was, from high to low, as follows: L group (23.7±2.8) µg·kg^-1·min^-1, M group (18.1±2.6)μg·kg^-1·min^-1, H group (16.42±2.3) μg·kg^-1·min^-1. The onset time from long to short was as follows: L group (108.4±8.6) s, M group (102.8±10.2)s, H group (96.9±8.2)s. The clinical efficacy ranged from long to short in the following order: H group (31.0±3.1)min, M group (27.0±3.2)min, L group (24.0±2.6) min, with significant differences (F=51.05, 60.54, 11.45, 40.76; all P values <0.001). However, no significant difference was found in the pump time, recovery index, and satisfaction score of intraoperative muscle relaxation among the three groups (all P values > 0.05). Conclusion In lumbar surgery, the lower the degree of fat infiltration in the paraspinal muscles of patients in the operation area, the greater the amount of rocuronium, the longer the onset time, and the shorter the clinical efficacy. The degree of fat infiltration in the paraspinal muscles could provide a reference for the individualized use of rocuronium in lumbar surgery.

Key words： Neuromuscular blockade Fat infiltration Rocuronium Muscle relaxation monitoring Spinal surgery

收稿日期: 2022-11-26

基金资助:国家自然科学基金（34100940）; 山西省教育厅高等学校科技创新项目（2013120）

通讯作者: 岳维,Email：45889535@qq.com

引用本文:

李晶, 岳维, 赵伟, 张林忠, 王静, 朱修锦. 腰椎手术中椎旁肌不同脂肪浸润程度对罗库溴铵使用剂量及效果的影响[J]. 中华解剖与临床杂志, 2023, 28(6): 376-381.
Li Jing, Yue Wei, Zhao Wei, Zhang Linzhong, Wang Jing, Zhu Xiujin. Effect of paravertebral muscle fat infiltration on dosage and effect of rocuronium use in lumbar surgery. Chinese Journal of Anatomy and Clinics, 2023, 28(6): 376-381.

链接本文:

http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20221126-00378 或 http://www.cjac.com.cn/CN/Y2023/V28/I6/376

[1]	Jeon I, Kim SW, Yu D.Paraspinal muscle fatty degeneration as a predictor of progressive vertebral collapse in osteoporotic vertebral compression fractures[J]. Spine J, 2022,22(2):313-320. DOI: 10.1016/j.spinee.2021.07.020
[2]	Doo AR, Lee JH, Lee Y, et al.Influence of the amount of skeletal muscle mass on rocuronium-induced neuromuscular block[J]. Anaesth Crit Care Pain Med, 2022,41(4):101086. DOI: 10.1016/j.accpm.2022.101086
[3]	Chang MY, Park Y, Ha JW, et al.Paraspinal lean muscle mass measurement using spine MRI as a predictor of adjacent segment disease after lumbar fusion: a propensity score-matched case-control analysis[J]. AJR Am J Roentgenol, 2019,212(6):1310-1317. DOI: 10.2214/AJR.18.20441
[4]	Mengiardi B, Schmid MR, Boos N, et al.Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: quantification with MR spectroscopy[J]. Radiology, 2006,240(3):786-792. DOI: 10.1148/radiol.2403050820
[5]	Gonzalez-Freire M, de Cabo R, Studenski SA, et al. The neuromuscular junction: aging at the crossroad between nerves and muscle[J]. Front Aging Neurosci, 2014,6:208. DOI: 10.3389/fnagi.2014.00208
[6]	Plaud B, Baillard C, Bourgain JL, et al.Guidelines on muscle relaxants and reversal in anaesthesia[J]. Anaesth Crit Care Pain Med, 2020,39(1):125-142. DOI: 10.1016/j.accpm.2020.01.005
[7]	Deschenes MR, Tenny KA, Wilson MH.Increased and decreased activity elicits specific morphological adaptations of the neuromuscular junction[J]. Neuroscience, 2006,137(4):1277-1283. DOI: 10.1016/j.neuroscience.2005.10.042
[8]	Yazici A, Yerlikaya T, Oniz A.An evaluation of the efficacy of a four-grade fat infiltration classification method, presented for the first time in literature[J]. BMC Musculoskelet Disord, 2022,23(1):226. DOI: 10.1186/s12891-022-05180-5
[9]	Bresnahan LE, Smith JS, Ogden AT, et al.Assessment of paraspinal muscle cross-sectional area after lumbar decompression: minimally invasive versus open approaches[J]. Clin Spine Surg, 2017,30(3):E162-E168.DOI: 10.1097/BSD.0000000000000038
[10]	Soltesz S, Stark C, Noé KG, et al.Comparison of the trapezius and the adductor pollicis muscle as predictor of good intubating conditions: a randomized controlled trial[J]. BMC Anesthesiol, 2017,17(1):106. DOI: 10.1186/s12871-017-0401-8
[11]	Fuchs-Buder T, Claudius C, Skovgaard LT, et al.Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents Ⅱ: the Stockholm revision[J]. Acta Anaesthesiol Scand, 2007,51(7):789-808. DOI: 10.1111/j.1399-6576.2007.01352.x
[12]	Betz M, Aguirre J, Schubert M, et al.Hand or foot train-of-four tests and surgical site muscle relaxation assessed with multiple motor evoked potentials: a prospective observational study[J]. Eur J Anaesthesiol, 2021,38(8):872-879. DOI: 10.1097/EJA.0000000000001398
[13]	Zhao X, Liang H, Hua Z, et al.The morphological characteristics of paraspinal muscles in young patients with unilateral neurological symptoms of lumbar disc herniation[J]. BMC Musculoskelet Disord, 2022,23(1):994. DOI: 10.1186/s12891-022-05968-5
[14]	Meyhoff CS, Lund J, Jenstrup MT, et al.Should dosing of rocuronium in obese patients be based on ideal or corrected body weight?[J]. Anesth Analg, 2009,109(3):787-792. DOI: 10.1213/ane.0b013e3181b0826a
[15]	Staehr-Rye AK, Rasmussen LS, Rosenberg J, et al.Surgical space conditions during low-pressure laparoscopic cholecystectomy with deep versus moderate neuromuscular blockade: a randomized clinical study[J]. Anesth Analg, 2014, 119(5): 1084-1092. DOI: 10.1213/ANE.0000000000000316
[16]	Althoff FC, Xu X, Wachtendorf LJ, et al.Provider variability in the intraoperative use of neuromuscular blocking agents: a retrospective multicentre cohort study[J]. BMJ Open, 2021,11(4): e048509. DOI: 10.1136/bmjopen-2020-048509
[17]	Hides J, Gilmore C, Stanton W, et al.Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects[J]. Man Ther, 2008, 13(1): 43-49. DOI: 10.1016/j.math.2006.07.017
[18]	Kim JC, Lee SU, Jung SH, et al.Natural aging course of paraspinal muscle and back extensor strength in community-dwelling older adults (sarcopenia of spine, SarcoSpine): a prospective cohort study protocol[J]. BMJ Open, 2019,9(9):e032443. DOI: 10.1136/bmjopen-2019-032443
[19]	Yazici A, Yerlikaya T.The relationship between the degeneration and asymmetry of the lumbar multifidus and erector spinae muscles in patients with lumbar disc herniation with and without root compression[J]. J Orthop Surg Res, 2022,17(1):541. DOI: 10.1186/s13018-022-03444-3
[20]	乔培柳, 塔依尔·阿不都哈德尔. 腰椎退行性疾病椎旁肌的渐进变化[J]. 中国组织工程研究, 2014,18(44):7205-7210. DOI:10.3969/j.issn.2095-4344.2014.44.028.Qiao PL, Tayier·Abuduhadeer. Change of paravertebral muscle in patients with lumbar degenerative disease[J]. Chinese Journal of Tissue Engineering Research, 2014,18(44):7205-7210. DOI: 10.3969/j.issn.2095-4344.2014.44.028
[21]	欧阳淼, 鲁世保, 孔超, 等. 退行性脊柱矢状面失衡患者腰椎椎旁肌的特点及其与失平衡程度之间的关系[J]. 中国脊柱脊髓杂志, 2021, 31(6): 488-496. DOI: 10.3969/j.issn.1004-406X.2021.06.02.Ouyang M,Lu SB,Kong C,et al.Characteristics of lumbar paravertebral muscle in degenerative sagittal imbalance and the association with the severity of sagittal deformity[J]. Chinese Journal of Spine and Spinal Cord,2021,3l(6):488-496.DOI: 10.3969/j.issn.1004-406X.2021.06.02
[22]	Jeong JS, Suh JK, Cho ES, et al.Antioxidant effect of muscle relaxants (vecuronium, rocuronium) on the rabbit abdominal aortic endothelial damage induced by reactive oxygen species[J]. Korean J Anesthesiol, 2013,65(6):552-558. DOI: 10.4097/kjae.2013.65.6.552
[23]	Choi YJ, Hee Kim Y, Bae GE, et al.Relationship between the muscle relaxation effect and body muscle mass measured using bioelectrical impedance analysis: a nonrandomized controlled trial[J]. J Int Med Res, 2019,47(4):1521-1532. DOI: 10.1177/0300060518822197