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2×ED95剂量顺式阿曲库铵采用预注给药法对小儿药效动力学的影响

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DOI:
作者:
魏嵘，杜晶慧，付月珍，金泉英，张马忠
WeiRong,DuJingHui,FuYueZhen,JinQuanYing,ZhangMaZho
作者单位:
上海市儿童医院麻醉科（魏嵘 杜晶慧 付月珍 金泉英）上海儿童医学中心麻醉科（张马忠)
Department of Anesthesiology,Children，s Hospital of Shanghai
关键词:
顺式阿曲库铵 ；预注；儿童
Cisatracurium;priming;pediatrics
摘要:
【摘要】 目的 观察儿童2×ED95剂量顺式阿曲库铵采用预注法给药对药效动力学及插管条件的影响。方法 39例2～10岁择期手术患儿, 美国麻醉医师学会（ASA）Ⅰ～Ⅱ级，随机分为三组，每组13例：D组（2×ED95单次剂量组）顺式阿曲库铵100ug/kg；Y组（2×ED95剂量预注组）先预注顺式阿曲库铵10ug/kg，5分钟后注入余量90ug/kg；S组（3×ED95剂量组）顺式阿曲库铵150ug/kg。麻醉诱导：咪达唑仑 0.2mg/kg 、芬太尼2μg/kg、丙泊酚2～4mg/kg，及相应剂量顺式阿曲库铵。麻醉维持：吸入50%O2-N2O、2%七氟醚和静脉微泵持续输注丙泊酚2mg﹒kg-1﹒h-1、术中根据需要追加芬太尼1μg/kg。采用肌松检测仪对尺神经进行连续四个成串（TOF）刺激监测。记录各组起效时间（肌松药注毕至第1次颤搐反应[T1]为最大抑制的时间）、阻滞维持时间（肌松药注毕至T1恢复到5% 的时间）、临床作用时间（肌松药注毕至T1恢复到25% 的时间）、体内作用时间（肌松药注毕至T1恢复到95% 的时间）及恢复指数（T1恢复从25%到75%的时间）；观察预注间期（预注量注毕至注入余下剂量的5分钟时间）T1及TOF的变化。结果 三组患儿年龄、性别、体重及插管条件评估分级之间无统计学差异（p＞0.05），预注间期T1及TOF无变化；S组起效时间明显短于D组和Y组（p＜0.05），而D组和Y组之间无显著性差异；S组和D组和Y组相比在阻滞维持时间、临床作用时间、体内作用时间明显延长（p＜0.05），D组和Y组之间无显著差异；三组恢复指数之间无显著性差异（p＞0.05）。结论 2×ED95剂量顺式阿曲库铵以10ug/kg为预注剂量余量为90ug/kg用于儿童麻醉诱导无明显优势。
【Abstract】Objective To observe the administration of 2 × ED95 dose of cisatracurium by priming technique on pharmacodynamic and intubating conditions in children.Methods 39 patients which scheduled for elective surgery, aged between 2 to 10 years old, ASA gradeⅠ or Ⅱ, were randomly divided into three groups according to the dose of cisatracurium, each group included 13 cases. Group D administrated of cisatracurium 100ug/kg; group Y administrated of cisatracurium 10ug/kg by priming technique, 5 minutes later administrated of cisatracurium 90ug/kg; group S administrated of cisatracurium 150ug/kg. Anesthesia was induced with midazolam 0.2mg/kg, fentanyl 2μg/kg, propofol 2～4mg/kg, and corresponding dose of cis-atracurium, and maintained with 50% O2-N2O, 2% sevoflure and continuous infusion of propofol 2mg﹒kg-1﹒h-1. 1μg/kg of fentanyl was added as required intraoperative. Neuromuscular block was assessed by monitoring the electromyographic response of the adductor pollicis to supramaximal train-of-four (TOF) stimulation. Onset time(time from cisatracurium administration to maximal depression of first twitch response[T1])、duration of peak effect(time from cisatracurium administration to 5% recovery of T1)、duration of clinical effect(time from cisatracurium administration to 25% recovery of T1)、 duration of total effect(time from cisatracurium administration to 95% recovery of T1)、recovery index(recovery of T1 from 25% to 75%) and changes of T1 and TOF in priming period were recorded.Results There were no significant differences among the three groups in age, gender, body weight, and intubation conditions (p＞ 0.05). The onset times in group S were significantly shorter than group D and group Y（p＜0.05）; but no significant differences were found between group D and group Y. The durations of clinical effect and durations of total effect in group S were significantly longer than group D and group Y（p＜0.05）; whereas there were no significant differences between group D and group Y; There were no differences in recovery index among three groups.Conclusions There was no benefit in priming cisatracurium 90ug/kg with 10ug/kg cisatracurium in pediatric anesthesia.

 

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