七氟烷和地氟烷对小儿手术中罗库溴铵持续输注速率的影响  

Influences of sevoflurane and desflurane on continuous infusion rate of rocuronium in children undergoing surgery

作　　者：康定鑫[1] 姬斌[1] 李军[1] 

机构地区：[1]温州医科大学附属第二医院育英儿童医院麻醉科,浙江温州325000

出　　处：《中国临床药理学杂志》2017年第21期2120-2123,共4页The Chinese Journal of Clinical Pharmacology

基　　金：浙江省医药卫生科技基金资助项目(2015KYA157);温州市公益性科技计划基金资助项目(Y20170142)

摘　　要：目的观察吸入1.3倍最低有效肺泡浓度(MAC)七氟烷和地氟烷对患儿手术中罗库溴铵持续输注速率的影响。方法全身麻醉下择期进行手术的患儿60例随机均分为试验组Ⅰ(地氟烷组)、试验组Ⅱ(七氟烷组)和对照组(丙泊酚组),每组20例。3组开始均用靶控输注丙泊酚(血浆浓度3~4μg·mL^(-1))诱导和维持麻醉,静脉滴注0.6 mg·kg^(-1)罗库溴铵气管插管。用肌松监测仪对腕部尺神经进行4个成串刺激(TOF),拇指内收肌依次出现4个肌颤搐分别记录为T_1、T_2、T_3和T_4。T_1恢复至5%开始输注罗库溴铵,调节输注速率始终维持T_1值在8%~10%,T_1稳定5 min时(t_0)的输注速度为初始输注速率,随即试验组Ⅰ和试验组Ⅱ停止输注丙泊酚,分别吸入七氟烷和地氟烷,并使呼气末浓度稳定于1.3 MAC,对照组继续输注丙泊酚。3组患儿每10 min记录一次罗库溴铵输注速率变化,各时点分别以t_1、t_2、t_3、t_4……表示(以此类推);停止肌肉松弛药后,记录Tl恢复至25%所需时间、Tl从25%恢复至75%所需时间(恢复指数)及四个成串刺激比(TOFr)恢复至90%所需时间。结果试验组Ⅰ、试验组Ⅱ和对照组患儿t_0时的罗库溴铵输注速率分别为(9.02±1.94),(9.25±2.01),(9.08±1.96)μg·kg^(-1)·min^(-1);试验组Ⅰ和试验组Ⅱ输注速率随吸入麻醉时间延长而显著下降(P<0.05),t7时试验组Ⅰ和试验组Ⅱ罗库溴铵输注速率分别为(4.49±0.98),(4.63±1.12)μg·kg^(-1)·min^(-1),而对照组则始终未见明显下降(P>0.05);试验组Ⅰ和试验组Ⅱt_1~t7输注速率均显著低于对照组(P<0.05);t_1~t_5试验组Ⅰ的输注速率均低于试验组Ⅱ(P<0.05)。试验组Ⅰ、试验组Ⅱ和对照组停药后T_1恢复至25%时间分别为(16.65±10.96),(24.30±2.35),(18.25±11.31)min;T_1从25%恢复至75%时间分别为(7.40±2.54),(14.11±3.07),(8.55±4.60)min;TOFr恢复至90%的时间分别为(39.58±4.07),(53.05±4.12),(40.72±5.85)min;与对照组比较,试验组Ⅰ肌肉�Objective To observe the influences of 1. 3 minimum alveolar concentration（ MAC） sevoflurane and desflurane on continuous infusion rate of rocuronium in children undergoing surgery. Methods Sixty children undergoing surgery under general anesthesia were randomlydivided into three groups consisting of 20 children each. At first all the patients adopted the target controlled infusion of propofol（ plasma concentration 3-4 μg·min^-1） for induction and maintenance of anesthesia,and accepted intravenous injection of 0. 6 mg· kg^-1 rocuronium for intubation. TOF-Watch SX monitor was used to exert a train-of-four stimulation（ TOF） at ulnar nerve in wrist,then the adductor pollicis muscle appeared muscle twitch 4 times in turn which was recorded T1,T2,T3 and T4 respectively. When T1 at 5%,intravenous infusion of rocuronium began and T1 was maintained at 8%-10% all the time. The infusion rate of rocuronium was defined the initial state when T1 at 8%-10% for 5 min（ t0）. Then the infusion of propofol stopped in desflurane group（ treatmentⅠgroup） and sevoflurane group（ treatmentⅡ group）,desflurane and sevoflurane began to be inhaled respectively and maintained end-tidal concentration at 1. 3 MAC. Control group continued infusion of propofol. The infusion rates of rocuronium were recorded every 10 min,which marked with t1,t2,t3,t4 respectively（ by such analogy）. The recovery times of muscle relaxant in three groups were recorded which including the times of Tlfrom 0 to 25%,T1 from 25% to 75%（ recovery index）,TOF ratio（ TOFr） from 0 to 90%. Results In treatmentⅠgroup,treatment Ⅱ group and control group,the initial infusion rates of rocuronium were（ 9. 02 ± 1. 94）,（ 9. 25 ± 2. 01）,（ 9. 08 ± 1. 96） μg·kg^-1·min^-1 respectively. The infusion rates gradually decreased in treatment Ⅰ group and treatment Ⅱ group after sevoflurane and desflurane were inhaled,which were（ 4. 49 ± 0. 98）,（ 4. 63 ± 1. 12） μg·kg^-1·min^-1 respectively at t7（ P〈0. 05）,th

关 键 词：小儿 罗库溴铵 七氟烷 地氟烷 神经肌肉阻滞 

分 类 号：R971.2[医药卫生—药品]