米库氯铵在不同年龄段婴幼儿静吸复合麻醉中的应用  

Application of mivacurium in infants and young children of different ages under combined intravenous-inhalational anesthesia

作　　者：包文娟[1] 石磊[1] 史静[1] 陈文静[1] 张琦 BAO Wen-juan;SHI Lei;SHI Jing;CHEN Wen-jing;ZHANG Qi(Department of Anesthesiology,Hebei Children′s Hospital,Shijiazhuang 050031,China)

机构地区：[1]河北省儿童医院麻醉科,河北石家庄050031

出　　处：《河北医科大学学报》2024年第7期844-849,F0002,共7页Journal of Hebei Medical University

基　　金：国家自然科学基金(82301382);河北省医学科学研究重点课题计划(20170382)。

摘　　要：目的 探讨不同剂量米库氯铵在不同年龄段婴幼儿静吸复合麻醉中的应用。方法 选择在河北省儿童医院拟进行全身麻醉手术患儿120例,按年龄分为Ⅰ组(患儿年龄2~12个月)Ⅱ组(患儿年龄13~36个月),再分别按米库氯铵首次剂量0.15 mg/kg、0.2 mg/kg随机分为Ⅰ_(0.15)组、Ⅰ_(0.2)组、Ⅱ_(0.15)组、Ⅱ_(0.2)组,每组30例。观测同时记录肌松时效相关指标,麻醉诱导前以及米库氯铵注射以后1 min、3 min和5 min的心率情况、平均动脉压和血氧饱和度的变化。结果 不同剂量米库氯铵起效时间比较:与Ⅰ_(0.15)组比较,Ⅰ_(0.2)组ThD_(75)、ThD_(90)和ThD_(max)明显缩短(P<0.05);与Ⅱ_(0.15)组比较,Ⅱ_(0.2)组ThD_(75)、ThD_(90)和ThD_(max)明显缩短(P<0.05)。不同年龄段米库氯铵起效时间的比较:与Ⅰ_(0.15)组比较,Ⅱ_(0.15)组ThD_(75)、ThD_(90)和ThD_(max)明显延长(P<0.05);与Ⅰ_(0.2)组比较,Ⅱ_(0.2)组ThD_(75)、和ThD_(max)明显延长(P<0.05)。各组Th、ThR25、ThR75、RI、TOFR75、TOFR90、气管插管满意率差异无统计学意义(P>0.05)。各组患儿心率、平均动脉压以及血氧饱和度在组间、时点间、组间·时点间交互作用差异均无统计学意义(P>0.05)。结论 影响肌松时效的相关因素包括患儿的年龄以及米库氯铵的首次给药剂量,0.15 mg/kg及0.2 mg/kg米库氯铵应用于婴幼儿全身麻醉是安全有效的。Objective To investigate application of different doses of mivacurium in infants and young children under combined intravenous-inhalational anesthesia.Methods A total of 120 children scheduled for surgery under general anesthesia at Hebei Children′s Hospital were selected.They were divided into groupⅠ(aged 2 to 12 months)and groupⅡ(aged 13 to 36 months)based on the age,and further randomly divided into subgroups based on the initial dose of mivacurium:0.15 mg/kg and 0.2 mg/kg,resulting in subgroupsⅠ_(0.15),Ⅰ_(0.2),Ⅱ_(0.15),andⅡ_(0.2),with 30 patients in each subgroup.The muscle relaxation-related indicators were observed and recorded,as well as the changes in heart rate(HR),mean arterial pressure(MAP),and blood oxygen saturation(SpO 2)before the anesthesia induction and at 1,3 and 5 min after the injection of mivacurium.Results Comparison of the onset time of the different dose of micuronium:compared with groupⅠ_(0.15),the ThD_(75),ThD_(90),and ThD_(max)of groupⅠ_(0.2)were obviously shortened(P<0.05);compared with groupⅡ_(0.15),the ThD_(75),ThD_(90),and ThD_(max)of groupⅡ_(0.2)were obviously shortened(P<0.05).Comparison of the onset time of mivacurium in different age groups:compared with groupⅠ_(0.15),the ThD_(75),ThD_(90),and ThD_(max)of groupⅡ_(0.15)were obviously prolonged(P<0.05);compared with groupⅠ_(0.2),the ThD_(75)and ThD_(max)of groupⅡ_(0.2)were obviously prolonged(P<0.05).There was no significant difference between the groups in Th,ThR 25,ThR 75,RI,TOFR 75,TOFR 90 and satisfaction rate of tracheal intubation(P>0.05).There was no significant difference in interaction between groups,time points and time points between groups with respect to HR,MAP and SpO 2(P>0.05).Conclusion The related factors affecting the neuromuscular blockade are the age of children and the first dose of mivacurium.Mivacurium(0.15 mg/kg,0.2 mg/kg)applied in pediatric anesthesia is safe and effective.

关 键 词：麻醉 米库氯铵 婴幼儿 肌松弛 

分 类 号：R726.142[医药卫生—儿科]