同剂量米库氯铵在不同年龄段小儿麻醉中的肌松时效研究

目的探讨不同剂量米库氯铵在不同年龄段小儿麻醉中的肌松时效.方法选取收治的72例拟行气管插管的择期手术患儿,根据年龄将入选患儿分为年龄≤3岁(Ⅰ组)和年龄3岁组(Ⅱ组),每组各36例.以上两组中再按首次给予米库氯铵的剂量(0.2,0.25 mg/kg)随机分为2个亚组,依次为Ⅰ0.2,Ⅰ0.25组和Ⅱ0.2,Ⅱ0.25组,每组各18例.当患儿肌颤搐反应恢复至25%时,间断给予0.1 mg/kg米库氯铵维持肌松状态.连续监测尺神经4个成串刺激的反应,观察肌肉时效指标;同时观察各组患儿的循环功能和不良反应情况.结果Ⅰ组患儿Th Dmax的起效时间明显短于Ⅱ组,两组患儿中0.25 mg/kg组的起效时间均明显高于0.2 mg/kg组,差异均有统计学意义(P0.05);各组患儿插管条件均为优或良,差异均无统计学意义(P0.05).各组患儿首次给药和多次追加米库氯铵的作用时间,末次追加米库氯铵患儿的各项恢复指数、TOFR75、TOFR90的时间之间差异均无统计学意义(P0.05);各组患儿给予米库氯铵后心率、血压与麻醉诱导前相比差异均无统计学意义(P0.05);未出现支气管哮喘,有少数患儿出现胸前、颈前皮肤潮红症状,在给药后10 min内均自行消退.结论米库氯铵在婴幼儿中的起效快于年龄3岁的儿童;0.25 mg/kg给药剂量起效快于0.2 mg/kg给药剂量组;神经肌肉功能恢复与小儿的年龄、追加次数无明显关联.

On Muscular Relaxation Time-Effect of Mivacurium with Different Doses in Pediatric Anesthesia at Different Ages

Objective To investigate the muscular relaxation time-effect of mivacurium with different doses in anaesthesia of children at different ages. Method 72 children were undergone endotracheal intubation. According to the age,the selected patients were randomly divided into age less than 3 years group ( Group I) and elder than 3 years group ( Group II) ,with 36 cases in each group. The above two groups were divided into two subgroups according to the first dose of mivacurium (0. 2,0. 25 mg/kg):group I0. 2 ,I0. 25 and groupⅡ0. 2 ,Ⅱ0. 25 , with 18 cases in each group. When the children twitch response recovered to 25%,intermittent administration of 0. 1mg/kg mivacurium was given to maintain muscle relaxation state. The reaction of ulnar nerve to 4 train stimulations were monitored continuously, the timeliness index of muscle was observed. At the same time, the circulation function and the adverse reactions of children in each group were recorded. Results The onset time of ThDmax in group I was significantly shorter than that in group II (P<0. 05),and the onset times of 0. 25 mg/kg subgroups in both the two groups were obviously higher than that in 0. 2 mg/kg subgroups (P<0. 05). The role of time each child first dose and multiple additional mivacurium, the difference between the time the last append append mivacurium children recovery index,TOFR75 and TOFR90 had no statistical significance (P>0. 05). The action time of first dose and multiple additional mivacurium,recovery indexes of the children administrated last append mivacurium, TOFR75 and TOFR90 exhibited no statistical significance differences between the groups ( P>0 . 05 ) . The differences of heart rate and blood pressure were not significant before and after the administration in each group (P>0. 05). There was no bronchial asthma occurred,and skin flush appeared on the chest and front neck of minority children which would regress in 10 min after administration. Conclusion Mivacurium in infants acted faster than in the children of more than 3 years old,and the action time of 0. 25 mg/kg dosage was shorter than that of 0. 2 mg/kg dosage. No significant association was conformed between pediatric neuromuscular function recovery and the age or the adding times.