儿童右美托咪定术前滴鼻用药对舒更葡糖钠拮抗罗库溴铵残余肌松的影响  

Effect of intranasal dexmedetomidine on the reversal of rocuronium‑induced residual neuromuscular blockade with sugammadex in pediatric patients

作　　者：薛彬[1] 张瑞冬[1] 郑吉建 Xue Bin;Zhang Ruidong;Zheng Jijian(Department of Anesthesiology,Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

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

出　　处：《国际麻醉学与复苏杂志》2024年第1期53-56,共4页International Journal of Anesthesiology and Resuscitation

基　　金：吴阶平医学基金会临床科研专项资助基金(320.6750.18198,320.6750.2020⁃21⁃16)。

摘　　要：目的探讨儿童右美托咪定术前滴鼻对舒更葡糖钠拮抗罗库溴铵残余肌松的影响。方法选取2020年4月至2020年11月择期行下腹部手术的患儿64例,美国麻醉医师协会分级Ⅰ、Ⅱ级,年龄1~12岁。采用随机数字表法将患儿分为实验组和对照组(每组32例),分别在麻醉诱导前给予右美托咪定1.0μg/kg或等容量生理盐水滴鼻。术中应用肌松监测仪四个成串刺激(TOF)模式监测肌松。术毕当肌松监测TOF T2再现时,两组患儿均静脉注射舒更葡糖钠2 mg/kg。记录患儿TOF比值(TOFR)恢复到0.9的时间;记录患儿一般情况、手术时间、术毕体温、拔管时间及麻醉后监测治疗室(PACU)滞留时间;记录肌松拮抗前即刻、拮抗后2 min、拮抗后5 min的脑电双频指数(BIS)、心率、收缩压、舒张压以及苏醒期皮疹、恶心、呕吐、躁动的发生情况。结果两组患儿一般情况、TOFR恢复至0.9的时间、手术时间、术毕体温差异无统计学意义(均P>0.05),实验组患儿拔管时间和PACU滞留时间较对照组明显较长(均P<0.05)。与对照组比较,实验组患儿肌松拮抗前即刻、拮抗后2 min BIS较低(均P<0.05),肌松拮抗前即刻收缩压较低(P<0.05);其余时点两组各指标差异无统计学意义(均P>0.05)。苏醒期两组患儿均未发生皮疹、恶心、呕吐,实验组患儿躁动发生率明显低于对照组(P<0.05)。结论儿童术前给予1μg/kg右美托咪定滴鼻不会延长2 mg/kg舒更葡糖钠拮抗罗库溴铵诱导残余肌松的恢复时间。Objective To explore the effect of intranasal dexmedetomidine on the reversal of rocuronium⁃induced residual neuro⁃muscular blockade with sugammadex in children.Methods A total of 64 children,American Society of Anesthesiologists gradeⅠorⅡ,aged from 1 to 9 years,who were scheduled for lower abdominal surgery from April 2020 to November 2020,were selected.Accord⁃ing to the random number table method,they were divided into two groups(n=32):an experimental group and a control group.Before sur⁃gery,they were intranasally administered with dexmedetomidine at 1.0μg/kg or with an equal volume of normal saline,respectively.Dur⁃ing surgery,train⁃of⁃four(TOF)stimulations were performed using a neuromuscular blockade monitor.After surgery,the patients were given sugammadex at 2.0 mg/kg in patients when TOF T2 appeared again during neuromuscular block monitoring.When TOF ratio(TO⁃FR)was recovered to 0.9,their following data were recorded,including general information,time to operation,temperature after surgery,time to extubation and the length of post⁃anesthesia care unit(PACU)stay.Meanwhile,the bispectral index(BIS)immediately before neu⁃romuscular block,heart rate,as well as 2 min and 5 min after antagonism,heart rate,systolic blood pressure,diastolic blood pressure and the incidences of rash,nausea,vomiting and agitation during the recovery period were recorded.Results There was no statistical dif⁃ference in general information,time to TOFR recovery to 0.9,time to operation and temperature after operation in the two groups(all P>0.05).The experimental group showed significantly extended time to extubation time and length of PACU stay(all P>0.05).Compared with the control group,the experimental group presented lower BIS immediately before antagonism and 2 min after sugammadex admin⁃istration(all P<0.05),with reduction in the systolic blood pressure immediately before sugammadex administration(P>0.05);and there was no statistical significance in the indexes between the two groups at other time p

关 键 词：儿童 右美托咪定 滴鼻给药 舒更葡糖钠 残余肌松 拮抗时间 

分 类 号：R726.1[医药卫生—儿科]