上海医学
上海醫學
상해의학
SHANGHAI MEDICAL JOURNAL
2010年
2期
136-139
,共4页
残余肌松作用%新斯的明%维库溴铵%拮抗%小儿麻醉
殘餘肌鬆作用%新斯的明%維庫溴銨%拮抗%小兒痳醉
잔여기송작용%신사적명%유고추안%길항%소인마취
Residual neuromuscular blockade%Neostigmine%Vecuronium%Antagonism%Pediatric anesthesia
目的 观察麻醉恢复期新斯的明拮抗小儿维库溴铵的残余肌松作用的剂量反应和安全性.方法 在全身麻醉下行择期手术的患儿50例,予维库溴铵首剂0.1 mg/kg,术中必要时追加0.05 mg/kg.应用加速度肌松监测仪监测4个成串反应的比值(TOFR).TOFR值恢复至0.55时,患者随机分为V_(10)、V_(20)、V_(30)、V_(50)和对照组,每组10例.V_(10)、V_(20)、V_(30)、V_(50)组分别给予新斯的明10、20、30和50μg/kg和阿托品5、10、15和25μg/kg,对照组静脉注射0.9%氯化钠溶液2 mL.观察TOFR值恢复至0.7、0.9、1.0的时间、心率和血压的变化,以及术后6、24 h恶心、呕吐的发生情况.结果 V_(10)、V_(20)、V_(30)、V_(50)组的TOFR恢复至0.7、0.9、1.0的时间均较对照组显著缩短(P值均<0.01),V_(20)组TOFR恢复至0.9的时间较V_(10)组显著缩短(P<0.05),V_(30)、V_(50)组TOFR恢复至0.9、1.0的时间较V_(10)组显著缩短(P值分别<0.05、0.01).5组患儿在静脉注射拮抗药物即刻及给药后5 min内的心率、血压的差异均无统计学意义(P值均>0.05).5组患儿在术后6、24 h的恶心、呕吐发生率的差异均无统计学意义(P值均>0.05).结论 当TOFR值已恢复至0.55时,仍应进行肌松作用的拮抗,不同剂量的新斯的明都能有效地拮抗小儿维库溴铵的残余肌松作用,推荐使用小剂量新斯的明,剂量不宜超过30μg/kg.
目的 觀察痳醉恢複期新斯的明拮抗小兒維庫溴銨的殘餘肌鬆作用的劑量反應和安全性.方法 在全身痳醉下行擇期手術的患兒50例,予維庫溴銨首劑0.1 mg/kg,術中必要時追加0.05 mg/kg.應用加速度肌鬆鑑測儀鑑測4箇成串反應的比值(TOFR).TOFR值恢複至0.55時,患者隨機分為V_(10)、V_(20)、V_(30)、V_(50)和對照組,每組10例.V_(10)、V_(20)、V_(30)、V_(50)組分彆給予新斯的明10、20、30和50μg/kg和阿託品5、10、15和25μg/kg,對照組靜脈註射0.9%氯化鈉溶液2 mL.觀察TOFR值恢複至0.7、0.9、1.0的時間、心率和血壓的變化,以及術後6、24 h噁心、嘔吐的髮生情況.結果 V_(10)、V_(20)、V_(30)、V_(50)組的TOFR恢複至0.7、0.9、1.0的時間均較對照組顯著縮短(P值均<0.01),V_(20)組TOFR恢複至0.9的時間較V_(10)組顯著縮短(P<0.05),V_(30)、V_(50)組TOFR恢複至0.9、1.0的時間較V_(10)組顯著縮短(P值分彆<0.05、0.01).5組患兒在靜脈註射拮抗藥物即刻及給藥後5 min內的心率、血壓的差異均無統計學意義(P值均>0.05).5組患兒在術後6、24 h的噁心、嘔吐髮生率的差異均無統計學意義(P值均>0.05).結論 噹TOFR值已恢複至0.55時,仍應進行肌鬆作用的拮抗,不同劑量的新斯的明都能有效地拮抗小兒維庫溴銨的殘餘肌鬆作用,推薦使用小劑量新斯的明,劑量不宜超過30μg/kg.
목적 관찰마취회복기신사적명길항소인유고추안적잔여기송작용적제량반응화안전성.방법 재전신마취하행택기수술적환인50례,여유고추안수제0.1 mg/kg,술중필요시추가0.05 mg/kg.응용가속도기송감측의감측4개성천반응적비치(TOFR).TOFR치회복지0.55시,환자수궤분위V_(10)、V_(20)、V_(30)、V_(50)화대조조,매조10례.V_(10)、V_(20)、V_(30)、V_(50)조분별급여신사적명10、20、30화50μg/kg화아탁품5、10、15화25μg/kg,대조조정맥주사0.9%록화납용액2 mL.관찰TOFR치회복지0.7、0.9、1.0적시간、심솔화혈압적변화,이급술후6、24 h악심、구토적발생정황.결과 V_(10)、V_(20)、V_(30)、V_(50)조적TOFR회복지0.7、0.9、1.0적시간균교대조조현저축단(P치균<0.01),V_(20)조TOFR회복지0.9적시간교V_(10)조현저축단(P<0.05),V_(30)、V_(50)조TOFR회복지0.9、1.0적시간교V_(10)조현저축단(P치분별<0.05、0.01).5조환인재정맥주사길항약물즉각급급약후5 min내적심솔、혈압적차이균무통계학의의(P치균>0.05).5조환인재술후6、24 h적악심、구토발생솔적차이균무통계학의의(P치균>0.05).결론 당TOFR치이회복지0.55시,잉응진행기송작용적길항,불동제량적신사적명도능유효지길항소인유고추안적잔여기송작용,추천사용소제량신사적명,제량불의초과30μg/kg.
Objective To study the dose-effect relationship and safety of different doses of neostigmine in antagonizing vecuronium-induced residual neuromuscular blockade in children. Methods The first dose of vecuronium was 0.1 mg/kg, and bolus dose of 0.05 mg/kg vecuronium was injected into 50 children when clinically needed during the surgeries. After an acceleromyography train-of-four ratio (TOFR) recovery of 0.55, children were randomly assigned to five groups (n=10). Group V_(10)、V_(20)、V_(30) and V_(50) were administrated with neostigmine (10, 20, 30 and 50 μg/kg) and atropine (5, 10, 15 and 25 μg/kg, respectively). Group C (group control) was administrated with 2 mL saline. Time of TOFR recovery to 0.7, 0.9 and 1.0, and heart rate and blood pressure were recorded. Nausea and vomiting (PONV) 6 h and 24 h after operation was also recorded. Results The recovery time periods of TOFR to 0.7, 0.9 and 1.0 were significantly shorter than those of the control group (P< 0.01) ; the recovery time period of TOFR to 0.9 in V_(20) group was significantly shorter than that in V_(10) group (P<0.05) ; the recovery time periods of Group V_(30) and V_(50) were significantly shorter than that of Group V_(10) (P<0.05). There were no differences in the heart rate, blood pressure and the incidences of PONV 6 h and 24 h after operation among the five groups (P>0.05). Conclusion When TOFR value recovers to 0.55, it is necessary to antagonize the residual block. Different doses of neostigmine can effectively antagonize vecuronium-induced residual neuromuscular blockade in children, but our results suggest low dose of neostigmine (>30 μg/kg) is suitable for antagonizing RNMB.
