不同年龄患儿罗库溴铵药效学的比较  

Comparison of pharmacodynamics of rocuronium in different age children

作　　者：刘金柱[1] 马维根[1] 

机构地区：[1]天津市儿童医院麻醉科,300074

出　　处：《中华麻醉学杂志》2009年第3期203-206,共4页Chinese Journal of Anesthesiology

摘　　要：目的比较新生儿、婴儿、幼儿和儿童罗库溴铵的药效学。方法择期全麻手术患儿160例，ASAⅠ或Ⅱ级，根据年龄分为4组（n=40）：新生儿组、婴儿组、幼儿组及儿童组。各组随机选取患儿20例，采用4次累积给药法静脉注射罗库溴铵，初始剂量：新生儿组40μg/kg，婴儿组80μg／kg，幼儿组及儿童组均为120μg／kg，后3次均追加罗库溴铵40μg／kg。每次给药后，观察TOF反应，当L连续3次稳定不变时，给予下一次剂量。采用概率单位法计算T1抑制50％、90％、95％的用药量（ED50、ED90、ED95）。各组随机选取20例患儿，静脉注射2倍ED9，剂量的罗库溴铵，记录肌松起效时间、高峰时间、临床肌松时间、体内作用时间和恢复指数。结果与新生儿组比较，幼儿组和儿童组罗库溴铵ED50、ED90和ED95均升高（P〈0．01），婴儿组上述指标差异无统计学意义（P〉0．05），婴儿组、幼儿组和儿童组罗库溴铵起效时间、临床肌松时间和体内作用时间缩短，恢复指数降低（P〈0．01）；与幼儿组比较，儿童组罗库溴铵ED50、ED90和ED95升高（P〈0．01）。结论不同年龄患儿对罗库溴铵的量效关系和时效关系存在明显的差别，新生儿对罗库溴铵的敏感性最强。Objective To compare pharmacodynamics of rocuronium in neonates, infants, young children and children. Methods One hundred and sixty ASA Ⅰ or Ⅱ pediatric patients undergoing elective surgical procedures under total intravenous anesthesia （TIVA） were divided into 4 groups according to ages （ n = 40 each） ： neonate group （0-28 d）, infant group （28 d 〈 age≤ 12 months）, young children group （1 yr 〈 age≤3 yr） and children group （3 yr 〈 age ≤ 10 yr）. Twenty patients were randomly selected from each group, and rocuronium was administered iv by using cumulative dose-response technique at four doses （an initial dose of 40 μg/kg, 80μg/kg, 120 μg/kg and 120μg/kg in neonate, infant, young children and children groups respectively, and three increments of 40μg/kg each）. After each administration, TOF response was observed. When T1 was stable, the next administration was given. 50% , 90% and 95% effective dose （ED50, ED90, ED95 ） were calculated by Probite method. Twenty patients were randomly selected in each group were given rocuronium 2 times of ED95 . The onset time, duration of peak effect, clinical duration, total duration and recovery index were recorded. Results ED50, ED90 and ED95 of roeuronium were significantly higher in young children and children groups than in neonate group （P 〈 0.01 ）, but there was no significant difference in the indices mentioned above between infant and neonate group （ P 〉 0.05）. Onset time of muscle relaxation, clinical duration and total duration were significantly shorter and recovery index lower in the other 3 groups than in neonate group （ P 〈 0.01 ）, but there was no significant difference in the duration of peak effect among the 4 groups （P 〉 0.05）. ED50, ED90 and ED95 of rocuronium were significantly higher in children group than in young children group （P 〈 0.01 ）. Conclusions There are significant differences in dose-effect and time-effect relationships among different age children and neonate is m

关 键 词：雄甾烷醇类 剂量效应关系 药物 年龄因素 儿童 

分 类 号：R614[医药卫生—麻醉学]