不同剂量顺式阿曲库铵对小儿肌松作用的比较  

Comparison of neuromuscular blocking effects of different doses of cisatracurium in children

作　　者：魏嵘[1,2] 卞勇[3] 张马忠[3] 陈煜[3] 

机构地区：[1]温州医学院,310033 [2]上海交通大学医学院附属上海儿童医学中心 [3]上海交通大学医学院附属上海儿童医学中心麻醉科

出　　处：《上海医学》2010年第2期156-158,共3页Shanghai Medical Journal

摘　　要：目的观察不同剂量顺式阿曲库铵在小儿麻醉中的肌松作用,探讨小儿合适的麻醉诱导剂量及对心血管的影响。方法选择45例择期手术患儿,年龄2～8岁,美国麻醉医师学会(ASA)分级Ⅰ～Ⅱ级,随机分为3组,每组15例。Ⅰ、Ⅱ、Ⅲ组分别予顺式阿曲库铵0.10、0.15、0.20 mg/kg。麻醉诱导:咪达唑仑0.2 mg/kg,芬太尼2μg/kg,丙泊酚2～4 mg/kg。麻醉维持:吸入N2O/O2(50/50)和2%七氟烷,经静脉微泵持续注射丙泊酚2 mg.kg-1.h-1,术中根据需要追加芬太尼1μg/kg。采用肌松检测仪对尺神经进行连续4个成串刺激(TOF),观察拇内收肌的加速度变化。记录各组起效时间[肌松药注射毕至第1次颤搐反应(T1)达最大抑制的时间]、阻滞维持时间(肌松药注射毕至T1恢复到5%的时间)、临床作用时间(肌松药注射毕至T1恢复到25%的时间)、体内作用时间(肌松药注射毕至T1恢复到95%的时间)及恢复指数(T1从25%恢复至75%的时间)。应用多功能监护仪监测注射顺式阿曲库铵前、后的血流动力学变化,同时观察患儿有无皮肤潮红及支气管痉挛等症状。结果3组间插管条件评估分级、恢复指数的差异均无统计学意义(P值均>0.05)。与给药前比较,3组注射顺阿曲库胺后1～5 min的收缩压、舒张压、心率的差异均无统计学意义(P值均>0.05)。Ⅱ、Ⅲ组的起效时间显著短于Ⅰ组(P值均<0.05),而Ⅱ组与Ⅲ组间的差异无统计学意义(P>0.05)。3组间阻滞维持时间、临床作用时间、体内作用时间的差异均有统计学意义(P值均<0.05)。结论小儿应用咪达唑仑、芬太尼和丙泊酚进行麻醉诱导时,顺式阿曲库铵0.15 mg/kg是理想的诱导剂量。Objective To determine the neuromuscular effects of different doses of cisatracurium in children,so as to investigate the suitable anesthesia induction dose and its influence on cardiovascular system.Methods Fory-five male and female（American Society of Anesthesiologists class Ⅰ-Ⅱ） patients,aged 2-8 years,who were scheduled for elective surgery under general anesthesia,were randomly assigned to three groups according to the doses of cisatracurium： group Ⅰ（0.10 mg/kg）,groupⅡ（0.15 mg/kg）,and group Ⅲ（0.20 mg/kg）.Anesthesia was induced with midazolam 0.2 mg/kg,fentanyl 2 μg/kg,and propofol 2-4 mg/kg,and maintained with N2O/ O2（50/50）,2% sevoflure and continuous infusion of propofol.Neuromuscular block was assessed by monitoring the electromyographic response of the adductor pollicis to supramaximal train-of-four（TOF） stimulation.Onset time（time from cisatracurium administration to maximal depression of first twitch response ）,duration of peak effect（time from cisatracurium administration to 5% recovery of T1）,duration of clinical action（time from cisatracurium administration to 25% recovery of T1）,duration of total action（time from cisatracurium administration to 95% recovery of T1） and recovery index（recovery of T1 from 25% to 75%） were recorded.The hemodynamic changes as well as symptoms such as erubescence and brochial spasm were also observed.Results There was no difference in the conditions of tracheal intubation among the three groups.There was no difference in the hemodynamic changes after the injection of cisatracurium between the three groups.The onset time periods in group Ⅱ and group Ⅲ were apparently shorter than that in group I,whereas there was no significant difference between group Ⅱ and group Ⅲ.The durations of peak effect,the durations of clinical action and durations of total action in three groups were significantly different.There was no difference in recovery index among the three groups.Conclusion Cisatracurium at 0.15 mg/kg is op

关 键 词：顺式阿曲库铵 神经肌肉阻滞 小儿 

分 类 号：R726.1[医药卫生—儿科]