CAJ | 학술논문

目的评价异丙嗪和地塞米松预处理对全麻手术患儿米库氯铵组胺释放的影响.方法择期行扁桃体或/和腺样体切除术的患儿80例,ASA分级Ⅰ或Ⅱ级,年龄4～ 10岁,体重14 ～ 30 kg.采用随机数字表法,将其分为4组(n=20):罗库溴铵组(R组)、米库氯铵组(M组)、地塞米松+米库氯铵组(DM组)和异丙嗪+米库氯铵组(PM组).DM组和PM组于麻醉前60 min时分别肌肉注射地塞米松0.2 mg/kg和盐酸异丙嗪0.5 mg/kg.麻醉诱导:静脉注射咪达唑仑、异丙酚和芬太尼,R组静脉注射罗库溴铵600μg/kg,M组、MD组和MP组静脉注射米库氯铵200 μg/kg.分别于给予肌松药前1min(To)、给予肌松药后1、3、5 min(T1-3)时记录MAP和HR,并抽取桡动脉血样3 ml,采用EILSA法测定血浆组胺浓度,同时观察患儿皮肤不良反应.结果与R组比较,M组T1-3时MAP降低,T1,2时HR和组胺浓度升高,皮肤不良反应分级升高,DM组T1,2时MAP降低,T1-3时HR升高,T1时组胺浓度升高,PM组T1时组胺浓度升高(P＜0.05);与M组比较,DM组T2时MAP升高,PM组T1-3时MAP升高,HR下降,T1,2时组胺浓度降低,DM组和PM组皮肤不良反应分级降低(P＜0.05).结论异丙嗪预处理可降低全麻手术患儿米库氯铵组胺释放,地塞米松预处理对其无影响.
목적 평개이병진화지새미송예처리대전마수술환인미고록안조알석방적영향.방법 택기행편도체혹/화선양체절제술적환인80례,ASA분급Ⅰ혹Ⅱ급,년령4～ 10세,체중14 ～ 30 kg.채용수궤수자표법,장기분위4조(n=20):라고추안조(R조)、미고록안조(M조)、지새미송+미고록안조(DM조)화이병진+미고록안조(PM조).DM조화PM조우마취전60 min시분별기육주사지새미송0.2 mg/kg화염산이병진0.5 mg/kg.마취유도:정맥주사미체서륜、이병분화분태니,R조정맥주사라고추안600μg/kg,M조、MD조화MP조정맥주사미고록안200 μg/kg.분별우급여기송약전1min(To)、급여기송약후1、3、5 min(T1-3)시기록MAP화HR,병추취뇨동맥혈양3 ml,채용EILSA법측정혈장조알농도,동시관찰환인피부불량반응.결과 여R조비교,M조T1-3시MAP강저,T1,2시HR화조알농도승고,피부불량반응분급승고,DM조T1,2시MAP강저,T1-3시HR승고,T1시조알농도승고,PM조T1시조알농도승고(P＜0.05);여M조비교,DM조T2시MAP승고,PM조T1-3시MAP승고,HR하강,T1,2시조알농도강저,DM조화PM조피부불량반응분급강저(P＜0.05).결론 이병진예처리가강저전마수술환인미고록안조알석방,지새미송예처리대기무영향.
Objective To evaluate the effects of promethazine or dexamethasone pretreatment on histamine release induced by mivacurium in pediatric patients.Methods Eighty pediatric patients,of ASA physical status Ⅰ or Ⅱ,aged 4-10 yr,weighing 14-30 kg,scheduled for elective tonsillectomy and adenoidectomy,were randomized into 4 groups (n =20 each) using a random number table:rocuronium group (group R),mivacurium group (group M),dexamethasone + mivacurium group (group DM) and promethazine + mivacurium group (group PM).Dexamethasone 0.2 mg/kg and promethazine 0.5 mg/kg were injected intramuscularly at 60 min before anesthesia in DM and PM groups,respectively.Anesthesia was induced with midazolam,propofol,fentanyl and rocuronium 600 μg/kg (in group R) or mivacurium 200 μg/kg (in M,MD and MP groups).At 1 min before administration of muscle relaxants and 1,3 and 5 min after administration of muscle relaxants,MAP and HR were recorded,blood samples were taken from the radial artery for determination of plasma histamine concentrations,and the cutaneous adverse reactions were observed.Results Compared with group R,MAP was significantly decreased at T1-3,HR and plasma histamine concentrations were increased at Ti,2,and the grade of cutaneous adverse reactions was increased in group M,MAP was decreased at T1,2,HR was increased at T1-3,plasma histamine concentrations were increased at T1 in group DM,and plasma histamine concentrations were increased at T1 in group PM.Compared with group M,MAP was significantly increased at T2 in group DM,MAP was increased and HR was decreased at T1-3,plasma histamine concentrations were decreased at T1,2 in group PM,and the grade of cutaneous adverse reactions was decreased in DM and PM groups.Conclusion Promethazine pretreatment can decrease the mivacurium-caused release of histamine in pediatric patients,while dexamethasone pretreatment has no such effects.