上海交通大学学报（医学版）

›› 2012, Vol. 32 ›› Issue (5): 650-.doi: 10.3969/j.issn.1674-8115.2012.05.026

• 论著（临床研究） • 上一篇    下一篇

米库氯铵用于小儿麻醉的肌松时效的临床观察

沈晓芳, 陈锡明, 赵 璇, 王英伟   

  1. 上海交通大学 医学院附属新华医院麻醉与重症医学科, 上海 200092
  • 出版日期:2012-05-28 发布日期:2012-06-01
  • 通讯作者: 陈锡明, 电子信箱: ximingchen@yahoo.com。
  • 作者简介:沈晓芳（1981—）, 女, 主治医师, 硕士；电子信箱: honeysxf@hotmail.com。

Neuromuscular blockade of mivacurium in pediatric anesthesia

SHEN Xiao-fang, CHEN Xi-ming, ZHAO Xuan, WANG Ying-wei   

  1. Department of Anesthesiology and Intensive Care, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
  • Online:2012-05-28 Published:2012-06-01

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摘要：

目的 观察不同剂量米库氯铵在不同年龄段患儿麻醉中的肌松时效。方法 择期手术患儿60例，美国麻醉师协会（ASA）评级为Ⅰ或Ⅱ级。按年龄分为婴幼儿组（≤3岁，Ⅰ组）和年长儿组（＞3岁，Ⅱ组），再根据米库氯铵首次剂量（0.2、0.25 mg/kg）每组随机分为2个亚组，分别为Ⅰ0.2、Ⅰ0.25组和Ⅱ0.2、Ⅱ0.25组，每组15例。当肌颤搐反应恢复至25%时，间断静脉注射米库氯铵0.1 mg/kg维持肌松。采用TOF-Watch SX加速度肌松监测仪连续监测尺神经4个成串刺激的反应（TOF）。观察并记录肌松时效指标。结果 Ⅰ0.25组肌松起效快于Ⅰ0.2、Ⅱ0.25组，Ⅱ0.25组起效快于Ⅱ0.2组，差异均有统计学意义（P<0.05）。各组间首次静脉注射及多次追加米库氯铵的临床作用时间、末次追加米库氯铵的恢复指数、第4个肌颤搐与第1个肌颤搐的比值（TOFR）恢复至0.75和0.9时间的差异均无统计学意义（P>0.05）。结论 米库氯铵在婴幼儿起效快于年长儿，0.25 mg/kg起效快于0.2 mg/kg；神经肌肉功能的恢复与患儿的年龄和追加次数无关。

关键词: 米库氯铵, 插管条件, 肌松效应, 小儿

Abstract:

Objective To evaluate the neuromuscular blockade of different doses of mivacurium in pediatric anesthesia. Methods Sixty children with American Society of Anesthesiologists （ASA） class Ⅰor Ⅱ undergoing selective surgery were randomly allocated to groupⅠ(≤3 years old) and groupⅡ (＞3 years old). Each group was subdivided according to the initial dosage of mivacurium (0.2 mg/kg or 0.25mg/kg)(groupⅠ0.2, group Ⅱ0.2, group Ⅰ0.25 and group Ⅱ0.25，n=15). At twitch recovery to 25%, neuromuscular blockade was maintained by intermittent intravenous injection of 0.1 mg/kg mivacurium. Response of ulnar nerve to train-of-four (TOF) stimulation was monitored with TOF-Watch SX muscle relaxation monitor, and the neuromuscular blockade indexes were recorded. Results The onset time in group Ⅰ0.25 was significantly shorter than that in group Ⅰ0.2 and group Ⅱ0.25（P<0.05）, and the onset time in group Ⅱ0.25 was significantly shorter than that in group Ⅱ0.2 (P<0.05). There was no significant difference in the duration of clinical action of initial dose and repeated dose of mivacurium among groups (P>0.05). There was no difference in the recovery index and duration of TOF ratio (TOFR) recovery to 0.75 and 0.9 of the last dose of mivacurium among groups (P>0.05). Conclusion Children younger than 3 years old have shorter onset time than elder ones, and 0.25 mg/kg mivacurium may produce shorter onset time than 0.2 mg/kg mivacurium. Neuromuscular recovery is independent of age and times of additional doses.

Key words: mivacurium, intubation condition, neuromuscular blockade, children