2×95%的有效药物剂量采用预注给药对儿童顺式阿曲库铵药效学的影响  

The pharmacodynamics of 2×the effective dose to produce 95% twitch depression of cisatracurium administrated by priming technique in children

作　　者：魏嵘[1] 杜晶慧[1] 付月珍[1] 金泉英[1] 张马忠[2] 

机构地区：[1]上海交通大学附属儿童医院麻醉科,200040 [2]上海交通大学附属儿童医学中心麻醉科

出　　处：《上海医学》2012年第2期108-110,共3页Shanghai Medical Journal

摘　　要：目的观察2×95%的有效药物剂量(ED95)采用预注给药对儿童顺式阿曲库铵药效学及气管插管条件的影响。方法 39例2～10岁美国麻醉医师学会分级Ⅰ～Ⅱ级行择期手术的患儿被随机分为3组,每组13例:D组(2×ED95单次剂量组)单次静脉注射顺式阿曲库铵100μg/kg;Y组(2×ED95预注组)先静脉预注顺式阿曲库铵10μg/kg,5min后注入余量90μg/kg;S组(3×ED95单次剂量组)单次静脉注射顺式阿曲库铵150μg/kg。麻醉诱导用咪达唑仑0.1mg/kg、芬太尼2μg/kg、丙泊酚2～4mg/kg及相应剂量顺式阿曲库铵。采用肌肉松弛监测仪对尺神经进行连续4个成串刺激(TOF)监测。记录各组起效时间[肌肉松弛药注射完毕至第1个肌颤搐反应高度(T1)消失为最大抑制时间]、阻滞维持时间(肌肉松弛药注射完毕至T1恢复到5%的时间)、临床作用时间(肌肉松弛药注射完毕至T1恢复到25%的时间)、体内作用时间(肌肉松弛药注射完毕至T1恢复到95%的时间)及恢复指数(T1从25%恢复到75%的时间);观察预注间期(预注量注射完毕至注入余下剂量前的5min)TOF的变化。结果 3组间年龄、性别构成、体重及气管插管条件评估分级间的差异均无统计学意义(P值均>0.05),Y组预注间期TOF值为1,无变化。S组的起效时间显著短于D组和Y组(P值均<0.05),但D组与Y组间差异无统计学意义(P>0.05)。S组的阻滞维持时间、临床作用时间、体内作用时间均较D组和Y组显著延长(P值均<0.05),D组与Y组间差异无统计学意义(P值均>0.05)。3组间恢复指数的差异均无统计学意义(P值均>0.05)。结论 2×ED95剂量顺式阿曲库铵以10μg/kg为预注剂量、90μg/kg为余量应用于儿童麻醉诱导无明显优势。无论预注与否,2×ED95剂量的效果均不及3×ED95。Objective To observe the effect of 2×the effective dose to produce 95% twitch depression（ED95） of cisatracurium administrated by priming technique on pharmacodynamics and intubating conditions in children. Methods A total of 39 children,aged from 2 to 10 years old,American Society of Anesthesiologists（ASA） grade Ⅰ or Ⅱ,scheduled for elective operation,were randomly divided into 3 groups（n=13）.The patients received a single bolus of cisatracurium 100 μg/kg,priming 10 μg/kg and then 90 μg/kg 5 minutes later,or a single bolus 150 μg/kg in groups D,Y and S,respectively.Anesthesia was induced with midazolam 0.1 mg/kg,fentanyl 2 μg/kg,propofol 2-4 mg/kg and corresponding dose of cisatracurium.Neuromuscular block was assessed by monitoring the electromyographic response of the adductor pollicis to supramaximal train-of-four（TOF） stimulation.The onset time（time from administration to maximal depression of the first twitch response ）,duration of peak effect（time from administration to 5% recovery of T1）,duration of clinical effect（time from administration to 25% recovery of T1）,duration of total effect（time from administration to 95% recovery of T1）,recovery index（recovery of T1 from 25% to 75%） and changes of TOF in priming period were recorded. Results There were no significant differences among groups in age,gender,body weight and intubation conditions（P0.05）.TOF was not changed in priming period in group Y.The onset time in group S was significantly shorter than that in groups D and Y（P0.05） and the durations of peak,clinical and total effects in group S were significantly longer than those in groups D and Y（P0.05）,but the differences between groups D and Y had no statistical significance（P0.05）.There was no difference in recovery index among groups（P0.05）. Conclusion There is no obvious advantage in pediatric anesthesia of priming 10 μg/kg and then 90 μg/kg cisatracurium.

关 键 词：顺式阿曲库铵 预注 儿童 药效学 

分 类 号：R726.1[医药卫生—儿科]