米库氯铵用于小儿麻醉的肌松时效的临床观察  

Neuromuscular blockade of mivacurium in pediatric anesthesia

作　　者：沈晓芳[1] 陈锡明[1] 赵璇[1] 王英伟[1] 

机构地区：[1]上海交通大学医学院附属新华医院麻醉与重症医学科,上海200092

出　　处：《上海交通大学学报（医学版）》2012年第5期650-653,共4页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的观察不同剂量米库氯铵在不同年龄段患儿麻醉中的肌松时效。方法择期手术患儿60例,美国麻醉师协会(ASA)评级为Ⅰ或Ⅱ级。按年龄分为婴幼儿组(≤3岁,Ⅰ组)和年长儿组(>3岁,Ⅱ组),再根据米库氯铵首次剂量(0.2、0.25mg/kg)每组随机分为2个亚组,分别为Ⅰ0.2、Ⅰ0.25组和Ⅱ0.2、Ⅱ0.25组,每组15例。当肌颤搐反应恢复至25%时,间断静脉注射米库氯铵0.1 mg/kg维持肌松。采用TOF-Watch SX加速度肌松监测仪连续监测尺神经4个成串刺激的反应(TOF)。观察并记录肌松时效指标。结果Ⅰ0.25组肌松起效快于Ⅰ0.2、Ⅱ0.25组,Ⅱ0.25组起效快于Ⅱ0.2组,差异均有统计学意义(P<0.05)。各组间首次静脉注射及多次追加米库氯铵的临床作用时间、末次追加米库氯铵的恢复指数、第4个肌颤搐与第1个肌颤搐的比值(TOFR)恢复至0.75和0.9时间的差异均无统计学意义(P>0.05)。结论米库氯铵在婴幼儿起效快于年长儿,0.25 mg/kg起效快于0.2 mg/kg;神经肌肉功能的恢复与患儿的年龄和追加次数无关。Objective To evaluate the neuromuscular blockade of different doses of mivacurium in pediatric anesthesia.Methods Sixty children with American Society of Anesthesiologists（ASA） class Ⅰor Ⅱ undergoing selective surgery were randomly allocated to groupⅠ（≤3 years old） and groupⅡ（3 years old）.Each group was subdivided according to the initial dosage of mivacurium（0.2 mg/kg or 0.25mg/kg）（groupⅠ0.2,group Ⅱ0.2,group Ⅰ0.25 and group Ⅱ0.25,n=15）.At twitch recovery to 25%,neuromuscular blockade was maintained by intermittent intravenous injection of 0.1 mg/kg mivacurium.Response of ulnar nerve to train-of-four（TOF） stimulation was monitored with TOF-Watch SX muscle relaxation monitor,and the neuromuscular blockade indexes were recorded.Results The onset time in group Ⅰ0.25 was significantly shorter than that in group Ⅰ0.2 and group Ⅱ0.25（P0.05）,and the onset time in group Ⅱ0.25 was significantly shorter than that in group Ⅱ0.2（P0.05）.There was no significant difference in the duration of clinical action of initial dose and repeated dose of mivacurium among groups（P0.05）.There was no difference in the recovery index and duration of TOF ratio（TOFR） recovery to 0.75 and 0.9 of the last dose of mivacurium among groups（P0.05）.ConclusionChildren younger than 3 years old have shorter onset time than elder ones,and 0.25 mg/kg mivacurium may produce shorter onset time than 0.2 mg/kg mivacurium.Neuromuscular recovery is independent of age and times of additional doses.

关 键 词：米库氯铵 插管条件 肌松效应 小儿 

分 类 号：R726.1[医药卫生—儿科]