中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
4期
286-288
,共3页
刘飞%彭夏莹%梁鹏%罗俊
劉飛%彭夏瑩%樑鵬%囉俊
류비%팽하형%량붕%라준
维库溴铵%眼科手术%全身麻醉
維庫溴銨%眼科手術%全身痳醉
유고추안%안과수술%전신마취
Vecuronium%Ocular surgery%General anesthesia
目的 验证眼科手术中低剂量维库溴铵(0.01 mg/kg)解决眼球偏心问题的有效性和安全性.方法 斜视或白内障手术患儿80例,年龄3～12岁,美国麻醉医师学会(ASA)分级Ⅰ～Ⅱ级,随机分为2组,每组40例.静脉注射芬太尼和异丙酚诱导插入喉罩后,两组分别注射维库溴铵0.01 mg/kg(L组),维库溴铵0.08 mg/kg(H组).安装ToF-Watch肌松监测仪,记录拇内收肌4个成串刺激中第4个肌颤搐与第1个肌颤搐的比值比例(TOFR).记录给药前后眼球偏心率,TOFR,眼球固定时间,肌松药总量,手术结束至喉罩拔出时间,眼科医生对眼球固定情况的满意度.结果 全身麻醉后,患儿眼球均发生偏移,L组患儿眼球偏心率0.30±0.11,H组眼球偏心率0.29 ±0.12(P=0.852).给予肌松药维库溴胺后,两组患儿眼球均能回复到正中心,L组眼球固定中心的时间是(23.43±2.45) min,明显短于H组(37.63±7.75) min(P ＜0.001).H组患儿TOFR在给药后降低至0,而L组TOFR仅轻微降低后随即恢复至给药前数值,手术结束时H组TOFR(80.47±5.53)％明显低于L组TOFR(102.43±4.70)％.眼科医生对两种剂量下眼球固定情况满意度差异无统计学意义(P=0.958).手术结束至喉罩拔出时间L组为(8.57±3.49) min,H组为(12.28±4.26) min(P=0.014).结论 低剂量维库溴铵(0.01 mg/kg)可安全有效地纠正眼科手术中眼球偏心问题,对呼吸肌抑制作用小,可缩短手术结束至喉罩拔出时间.
目的 驗證眼科手術中低劑量維庫溴銨(0.01 mg/kg)解決眼毬偏心問題的有效性和安全性.方法 斜視或白內障手術患兒80例,年齡3～12歲,美國痳醉醫師學會(ASA)分級Ⅰ～Ⅱ級,隨機分為2組,每組40例.靜脈註射芬太尼和異丙酚誘導插入喉罩後,兩組分彆註射維庫溴銨0.01 mg/kg(L組),維庫溴銨0.08 mg/kg(H組).安裝ToF-Watch肌鬆鑑測儀,記錄拇內收肌4箇成串刺激中第4箇肌顫搐與第1箇肌顫搐的比值比例(TOFR).記錄給藥前後眼毬偏心率,TOFR,眼毬固定時間,肌鬆藥總量,手術結束至喉罩拔齣時間,眼科醫生對眼毬固定情況的滿意度.結果 全身痳醉後,患兒眼毬均髮生偏移,L組患兒眼毬偏心率0.30±0.11,H組眼毬偏心率0.29 ±0.12(P=0.852).給予肌鬆藥維庫溴胺後,兩組患兒眼毬均能迴複到正中心,L組眼毬固定中心的時間是(23.43±2.45) min,明顯短于H組(37.63±7.75) min(P ＜0.001).H組患兒TOFR在給藥後降低至0,而L組TOFR僅輕微降低後隨即恢複至給藥前數值,手術結束時H組TOFR(80.47±5.53)％明顯低于L組TOFR(102.43±4.70)％.眼科醫生對兩種劑量下眼毬固定情況滿意度差異無統計學意義(P=0.958).手術結束至喉罩拔齣時間L組為(8.57±3.49) min,H組為(12.28±4.26) min(P=0.014).結論 低劑量維庫溴銨(0.01 mg/kg)可安全有效地糾正眼科手術中眼毬偏心問題,對呼吸肌抑製作用小,可縮短手術結束至喉罩拔齣時間.
목적 험증안과수술중저제량유고추안(0.01 mg/kg)해결안구편심문제적유효성화안전성.방법 사시혹백내장수술환인80례,년령3～12세,미국마취의사학회(ASA)분급Ⅰ～Ⅱ급,수궤분위2조,매조40례.정맥주사분태니화이병분유도삽입후조후,량조분별주사유고추안0.01 mg/kg(L조),유고추안0.08 mg/kg(H조).안장ToF-Watch기송감측의,기록무내수기4개성천자격중제4개기전휵여제1개기전휵적비치비례(TOFR).기록급약전후안구편심솔,TOFR,안구고정시간,기송약총량,수술결속지후조발출시간,안과의생대안구고정정황적만의도.결과 전신마취후,환인안구균발생편이,L조환인안구편심솔0.30±0.11,H조안구편심솔0.29 ±0.12(P=0.852).급여기송약유고추알후,량조환인안구균능회복도정중심,L조안구고정중심적시간시(23.43±2.45) min,명현단우H조(37.63±7.75) min(P ＜0.001).H조환인TOFR재급약후강저지0,이L조TOFR부경미강저후수즉회복지급약전수치,수술결속시H조TOFR(80.47±5.53)％명현저우L조TOFR(102.43±4.70)％.안과의생대량충제량하안구고정정황만의도차이무통계학의의(P=0.958).수술결속지후조발출시간L조위(8.57±3.49) min,H조위(12.28±4.26) min(P=0.014).결론 저제량유고추안(0.01 mg/kg)가안전유효지규정안과수술중안구편심문제,대호흡기억제작용소,가축단수술결속지후조발출시간.
Objective To test the effectiveness and safety of low-dose vecuronium (0.01 mg/kg) for correcting eccentric eye position during ocular surgery.Methods A total of 80 ASA Ⅰ-Ⅱ children undergoing cataract or squint surgery were randomized into 2 groups (n =40 each).Fentanyl and propofol were used for induction and then laryngeal mask (LMA) was inserted.0.01 mg/kg vecuronium was administered to the low-dose group (L group) and 0.08 mg/kg vecuronium for high-dose group (H group).The ToF-Watch was fixed to monitor the train of four ratio (TOFR) of adductor pollicis.Eyeball eccentricity ratio before and after dosing,TOFR,duration of eyeball in central position,duration of surgery,the time from the end of surgery to removal of LMA and oculist satisfaction were recorded.Results The incidence of eccentric eyeball position was nearly 100％ in both groups.The eyeball eccentricity ratio was 0.30 ±0.11 in L group and 0.29 ± 0.12 in H group (P =0.852)after/before vecuronium injection.The eyeballs were fixed well in the central position in both groups after vecuronium injection.The duration was shorter in L group than that in H group (23.43 ±2.45 vs 37.63 ±7.75 min,P ＜0.001).The time from the end of surgery to removal of LMA was (8.57 ± 3.49) min in L group and (12.28 ±4.26) min in H group (P =0.014).TOFR had merely mild reduction in L group and returned to normal in 10 minutes.At the end of surgery,TOFR was 102.43％ ± 4.70％ in L group and 80.47 ± 5.53 in H group (P ＜ 0.001).Oculists were satisfied with eyeball position in both groups (P =0.958).Conclusion Low-dose vecuronium can correct eccentric eyeball position effectively and safely during ocular surgery while it has little effect on respiratory muscles.
