两种肌松药在小儿气道异物取出术中的疗效分析  

Therapeutic Analysis of Two Kinds of Muscular Relaxation in Airway Foreign Body Removal Operation in Children

作　　者：黄建强[1] 王宏梗[2] 黄方[1] 陈汝聘[2] 许志辉[1] 

机构地区：[1]福建医科大学附属第二医院耳鼻咽喉头颈外科,福建泉州362000 [2]福建医科大学附属第二医院麻醉科,福建泉州362000

出　　处：《中山大学学报（医学科学版）》2017年第4期569-575,共7页Journal of Sun Yat-Sen University:Medical Sciences

摘　　要：【目的】观察罗库溴铵与琥珀胆碱在小儿气道异物取出术中维持肌松的临床效果、术中术后并发症的发生及术后拔管、肌力恢复情况。【方法】选择我院2013年1月至2016年1月80例择期行气道异物取出术患儿,其中30例为年龄大于3岁患儿,根据麻醉诱导时静注的肌松药随机分为2组(n=40):罗库溴铵组(R组)0.9 mg/kg,琥珀胆碱组(S组)1.5 mg/kg;术中根据肌松程度及手术时间,R组必要时追加静注罗库溴铵0.3 mg/kg,S组必要时追加静注琥珀胆碱0.5 mg/kg,其余用药一致。观察项目包括:支气管镜置入条件比较,术中肌松程度,追加静注肌松药和阿托品的次数,气管插管拔除时间,术中术后生命征、血流动力学动态观察及并发症的发生情况,年龄大于3岁患儿术后24 h肌肉酸痛发生率。【结果】(1)两组患儿支气管镜置入条件比较差异无统计学意义(P>0.05)。(2)两组术中肌松程度无明显差别,但R组患儿均无需追加肌松药及阿托品,而S组所有患儿均需追加肌松药和阿托品,两组间比较差异有统计学意义(P<0.01)。(3)术中术后生命征、血流动力学动态观察平稳,两组间比较差异无统计学意义(P>0.05);S组患儿有出现体动、低氧血症、苏醒期躁动等并发症,而R组仅出现喉痉挛及苏醒期躁动各1例,两组间比较差异有统计学意义(P<0.05)。(4)术后15 min S组患儿肌力恢复比R组明显,肌力恢复程度与R组比较差异有统计学意义(P<0.01)。(5)手术结束后气管插管拔除时间R组患儿比S组延长,差异有统计学意义(P<0.05)。(6)术后24 h随访30例年龄大于3岁患儿,S组(14例)患儿表现为躯干及四肢肌肉酸痛;R组(16例)患儿均无全身肌肉酸痛发生,两组比较差异有显著统计学意义(P<0.01)。【结论】小儿气道异物取出术中应用罗库溴铵与琥珀胆碱均有较好肌松效果,前者肌松效果更佳,安全性更好,可提供更好的手术条件和持续平衡的麻醉深度,[ Objective ] To observe the muscle relaxation clinical effect and the occurrence of intraoperative and postoperative complications, and the postoperative extubation and muscle strength recovery of Rocuronium and Succinylcholine in children during airway foreign body removal operation. [Methods] 80 cases of children （ASA I ） with airway foreign body, among them, 30 cases were older than 3 years old, were agreed to be on electively airway foreign body removal surgery. According to anesthesia induction, intravenous injection muscle relaxants were randomly divided into two groups （n = 40） ： Roeuronium group （Group R） 0.9 mg/kg, Suecinylcholine group （Group S） 1.5 mg/kg. According to the degree of muscle relaxation and operation time, if necessary, patients in Group R were added intravenous injection with Rocuronium 0.3 mg/kg, patients in Group S were added intravenous injection with Succinylcholine 0.5 mg/kg, the other drugs were consistent. Observation items included ： the bronchoscopy conditions, the degree of muscle relaxation during operation, the numbers of intravenous injection muscle relaxant and atropine, the times of tracheal extu-bation, the dynamic observation about vital sign and hemodynamic intraoperative and postoperative, and the occurrence situation of complications, the incidence rate of muscle soreness in children older than 3 years old 24 h after operation. [ Results ] （ 1 ） There was no significant statistics difference between the two groups in the condition of bronchoscopy （P 〉 0.05）. （2） The patients in Group R were not required to add muscle relaxants and atropine, but all patients in Group S were required to add muscle relaxants and atro- pine （P 〈 0.01 ）. （3）The complications such as body movement, hypoxemia, restlessness during recovery period were hap- pened in Group S, and in Group R, there were only 1 case of lal-cngeal spasm and restlessness during recovery period, there was sta- tistically significant difference between the two groups （P �

关 键 词：罗库溴铵 琥珀胆碱 全身麻醉 气道异物 支气管镜检查术 

分 类 号：R614[医药卫生—麻醉学]