舒更葡糖钠拮抗小儿扁桃体手术后罗库溴铵肌松作用的观察  

Efficacy and Safety of Sugammadex in Reversing Rocuronium-induced Neuromuscular Blockade in Children Post Elective Tonsillectomy

作　　者：姜燕 魏嵘[2] 张瑞冬[1] 郑吉建[1] JIANG Yan;WEI Rong;ZHANG Ruidong;ZHENG Jijian(Department of Anesthesiology,Shanghai Children's Medical Center,Shanghai JiaoTong University School of Medicine,Shanghai 200127;Department of Anesthesiology,Shanghai Children's Hospital,Shanghai 200062)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心麻醉科,上海200127 [2]上海市儿童医院,上海交通大学附属儿童医院麻醉科,上海200062

出　　处：《药学与临床研究》2020年第2期139-141,共3页Pharmaceutical and Clinical Research

基　　金：吴阶平医学基金会临床科研专项资助基金(320.675018198)。

摘　　要：目的:观察舒更葡糖钠对小儿扁桃体术后拮抗罗库溴铵残余肌松的效果和安全性。方法:选择年龄3~6岁,体重12~23 kg,ASA分级I^II级拟行择期小儿扁桃体手术的60例患儿为研究对象。按照随机数字表法将患儿分为2组:舒更葡糖钠组(S组)和新斯的明组(X组),每组30例。肌松监测采用4个成串刺激(TOF)模式,术毕待T2出现时,S组患儿静脉注射舒更葡糖钠2 mg·kg^-1,X组患儿注射新斯的明40μg·kg^-1和阿托品20μg·kg^-1拮抗肌松残余。记录患儿TOF值,从给药到恢复至90%的时间以及术毕到拔除气管导管的时间;观察两组患儿给药前后血流动力学指标(收缩压、舒张压和心率);记录舒更葡糖钠给药后的不良反应。结果:S组TOF值恢复至90%的时间和拔管时间均较X组显著缩短,分别为1.4±0.2 vs 8.5±1.8 min、3.8±1.1 vs 10.7±1.2 min,P值均<0.01。与X组比较,S组患儿给药前后心率更加平稳;两组患儿心动过缓、呼吸抑制、恶心与呕吐和再次插管等并发症的发生率无明显差别。结论:舒更葡糖钠可以快速有效拮抗小儿扁桃体术后罗库溴铵残余的肌松作用,缩短术后拔管时间,对患儿血流动力学无明显影响且并发症较少。Objective:To validate the effectiveness and safety of sugammadex in reversing rocuronium-induced neuromuscular blockade in children post tonsillectomy.Methods:A total of 60 children with ASA grade I-II,aged 3 to 6 years old,weighing 12 kg to 23 kg and waiting for tonsillectomy,were enrolled in this study.The children were then divided into sugammadex group(Group S)and neostigmine group(Group X)according to the random number table with 30 cases in each group.Neuromuscular blockade was monitored by the train-of-four ratio(TOFR).Patients in the Group S received sugammadex 2 mg·kg^-1 for reverse of residual neuromuscular blockade when T2 appeared,while pantients in the Group X received neostigmine 40μg·kg^-1 and atropine 20μg·kg^-1 for the same purpose.Results:The recovery time to TOF>0.9 and the extubation time were shorter in Group S than in Group X[(1.4±0.2)vs(8.5±1.8)min,(3.8±1.1)vs(10.7±1.2)min,respectively,P<0.01].Heart rates were more stable in Group S compared with those in the Group X;The incidence of complications such as bradycardia,respiratory depression,nausea and vomiting,and the reintubation rates were similar in both groups.Conclusion:Sugammadex may quickly reverse the residual neuromuscular blockade and shorten the time of postoperative extubation,with no more hemodynamics or other side effects.

关 键 词：舒更葡糖钠 小儿 罗库溴铵 四个成串刺激 

分 类 号：R969.4[医药卫生—药理学]