舒更葡糖对小儿心脏手术后C反应蛋白和降钙素原的影响

Effects of sugammadex on postoperative C-reactive protein and procalcitonin in children undergoing heart surgery

目的评价舒更葡糖拮抗小儿心脏术后残余肌松的效果及对术后C反应蛋白(CRP)和降钙素原(PCT)的影响。方法选择拟行择期心脏手术的患儿40例,年龄2~6岁,ASAⅡ级,随机分为对照组和试验组,每组20例。2组患儿麻醉诱导和维持方案相同。当肌松监测强直刺激后刺激计数(PTC)为1~2和四个成串刺激(TOF)值为0时,对照组给予新斯的明40μg·kg^(-1)复合阿托品20μg·kg^(-1)静脉注射,试验组给予舒更葡糖2 mg·kg^(-1)静脉注射。记录2组TOF值恢复至0.9的时间、机械通气时间和拔管时间,观察给药前后患儿血流动力学指标和不良反应发生情况,检测术前和术后24 h患儿血CRP和PCT水平。结果与对照组相比,试验组TOF值恢复时间、机械通气时间和拔管时间均显著缩短[(110.6±22.3)min vs.(4.6±1.8)min,(181.5±23.5)min vs.(67.3±7.1)min,(189.8±24.7)min vs.(68.8±7.9)min,均P<0.05]。与术前相比,2组术后24 h血CRP和PCT水平均显著升高(P<0.05),且术后24 h试验组低于对照组(P<0.05)。给药前后2组患儿平均动脉压、心率和中心静脉压均无显著变化(P>0.05),且2组不良反应发生率无显著差异(P>0.05)。结论舒更葡糖能快速拮抗小儿心脏术后罗库溴铵诱导的残余肌松,显著缩短机械通气时间和拔管时间,还可以减少术后CRP和PCT的释放。

AIM To evaluate the effects of sugammadex as a reversal agent on postoperative residual neuromuscular block and C-reactive protein(CRP)and procalcitonin(PCT)in children undergoing heart surgery.METHODS Forty pediatric patients undergoing elective heart surgery,aged 2 to 6 years,ASA,were randomly assigned into the control group and the experiment group(20 cases in each group).The induction and maintenance of anesthesia were the same in both groups.When the muscle relaxation was monitored for post-tetanic count stimulation(PTC)=1 to 2 and train of four(TOF)=0,the control group received neostigmine 40μg·kg^(-1)plus atropine 20μg·kg^(-1),and the experiment group received sugammadex 2 mg·kg^(-1).The recovery time of TOF=0.9,mechanical ventilation time and extubation time were recorded.The hemodynamic parameters after administration and adverse reactions were also recorded.The levels of CRP and PCT before and 24 h after surgery were measured.RESULTS Compared with the control group,the time to TOF rate of 0.9,duration of mechanical ventilation,and extubation time were significantly shorter in the experiment group((110.6±22.3)min vs.(4.6±1.8)min,(181.5±23.5)min vs.(67.3±7.1)min,(189.8±24.7)min vs.(68.8±7.9)min,respectively,P<0.05).Compared with those before surgery,and the levels of CRP and PCT were significantly increased 24 hours after surgery in both groups(P<0.05),and the levels of CRP and PCT in the experiment group were lower than those in the control group at 24 hours after surgery(P<0.05).There were no statistical differences in terms of mean arterial pressure,heart rate,central venous pressure and adverse reactions between the two groups(P>0.05).CONCLUSION Sugammadex is fast in reversing rocuronium-induced residual neuromuscular block,can shorten the mechanical ventilation time and extubation time,and reduce the release of postoperative CRP and PCT in children undergoing heart surgery.