上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (11): 1625-.doi: 10.3969/j.issn.1674-8115.2011.11.026

• 论著（临床研究） • 上一篇    下一篇

顺式阿曲库铵在儿童早期插管中的应用研究

魏 嵘, 杜晶慧, 付月珍, 金泉英   

  1. 上海市儿童医院 上海交通大学附属儿童医院麻醉科, 上海 200040
  • 出版日期:2011-11-28 发布日期:2011-11-29
  • 通讯作者: 金泉英, 电子信箱: jinquanying@sohu.com。
  • 作者简介:魏 嵘（1968—）, 男, 副主任医师, 硕士；电子信箱: ej8710@sina.com。

Application of cisatracurium in rapid tracheal intubation in children

WEI Rong, DU Jing-hui, FU Yue-zhen, JIN Quan-ying   

  1. Department of Anesthesiology, Children's Hospital, Shanghai Jiaotong University, Shanghai 200040, China
  • Online:2011-11-28 Published:2011-11-29

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摘要：

目的 观察丙泊酚联合芬太尼诱导麻醉下顺式阿曲库铵对儿童早期插管及插管条件的影响。方法 60例2～10岁择期行腺样体吸割手术患儿按所给肌松药和剂量随机分为Ⅰ组（顺式阿曲库铵0.1 mg/kg）、Ⅱ组（顺式阿曲库铵0.15 mg/kg）和Ⅲ组（罗库溴铵0.6 mg/kg），每组20例。以丙泊酚联合芬太尼和相应剂量的肌松药进行麻醉诱导，注入肌松药后1 min试行气管插管，采用肌松检测仪对尺神经进行连续4个成串（TOF）刺激，监测拇内收肌的颤搐变化，记录各组1 min插管时TOF中的第1次颤搐(T1)值及起效时间（肌松药注毕至T1为最大阻滞的时间）；评价插管条件分级。结果 注入肌松药后1 min，Ⅱ组和Ⅲ组插管条件评分明显好于Ⅰ组（P＜0.05），Ⅱ组和Ⅲ组之间插管条件评分差异无统计学意义（P＞0.05）。1 min试行气管插管时，外周监测拇内收肌肌松作用显示3组患儿T1并没达到最大阻滞，Ⅱ组和Ⅲ组对神经肌肉功能的阻滞程度明显快于Ⅰ组（P＜0.05），肌松药起效时间Ⅱ组和Ⅲ组明显快于Ⅰ组（P＜0.05），Ⅱ组和Ⅲ组之间差异无统计学意义（P＞0.05）。结论 在丙泊酚联合芬太尼诱导麻醉下，0.15 mg/kg顺式阿曲库铵可用于快速诱导早期气管插管，肌松药注入后1 min行气管插管可得到较为理想的气管插管条件。

关键词: 顺式阿曲库铵, 早期插管, 儿童

Abstract:

Objective To observe the effect of cisatracurium on rapid tracheal intubation and intubation conditions in children under anesthesia with fentanyl and propofol. Methods Sixty children scheduled for adenotonsillectomy were randomly divided into group Ⅰ(0.1 mg/kg cisatracurium), group Ⅱ(0.15 mg/kg cisatracurium) and group Ⅲ (0.6 mg/kg rocuronium) according to muscle relaxant types and doses, with 20 children in each group. Anesthesia was induced with propofol, fentanyl and corresponding doses of muscle relaxant. Tracheal intubation was attempted 1 min after administration of muscle relaxant. Neuromuscular block was assessed by monitoring the electromyographic response of the adductor pollicis response to train-of-four (TOF) stimulations. The first twitch response (T1) and onset time (time from administration of muscle relaxant to maximal depression of T1) were recorded. Intubation conditions were evaluated. Results The scores of intubation conditions in group Ⅱ and group Ⅲ were significantly better than that in group Ⅰ 1 min after administration of muscle relaxant (P＜0.05), while there was no significant difference between group Ⅱ and group Ⅲ (P＞0.05). The maximal neuromuscular block effects of T1 were not achieved in three groups at the time of intubation. Maximum suppression of T1 in group Ⅱ and group Ⅲ was significantly shorter than that in group Ⅰ（P＜0.05）, time of action of muscle relaxant in group Ⅱ and group Ⅲ was significantly faster than that in group Ⅰ（P＜0.05）, while no significant difference was found between group Ⅱ and group Ⅲ (P＞0.05). Conclusion Favorable rapid tracheal intubation conditions can be obtained 1 min after administration of 0.15 mg/kg cisatracurium under anesthesia with fentanyl and propofol in children.

Key words: cisatracurium, rapid tracheal intubation, children