地氟醚对小儿罗库溴铵肌松作用的影响

Effect of Desflurane on Rocuronium-induced Neuromuscular Blockade in Children.

目的研究地氟醚对小儿罗库溴铵量效关系、肌松时效及输注速率的影响。方法将80例小儿随机分为2组,异丙酚组(P组),予静脉输入异丙酚6～8mg/kg-1/min-1;地氟醚组(D组),持续吸入6%地氟醚。用TOF-Guard加速度肌松监测仪(Organon)监测神经肌肉功能。分3期进行观察。第1部分每组20例,用异丙酚/地氟醚麻醉维持60min后,用2次给药技术建立量效关系曲线,计算ED50、ED90和ED95;第二部分每组10例,用异丙酚/地氟醚麻醉维持60min后静脉注射罗库溴铵600μg/kg,记录起效时间、作用时间和恢复时间;第3部分每组10例,诱导后静脉注射罗库溴铵600μg/kg,待T1恢复至5%时吸入地氟醚(D组)或输注异丙酚(P组),同时静脉输注罗库溴铵维持T1于5%左右,每15min记录1次罗库溴铵输注速率,共4次。结果P组ED50、ED90、ED95分别为188.7μg/kg、316.3μg/kg、366.2μg/kg,D组ED50、ED90、ED95分别为157.4μg/kg、263.9μg/kg、305.5μg/kg,D组均小于P组,P<0.05;P组与D组的起效时间分别为83s±5s、70s±6s,临床肌松时间分别为25min±4min、31min±3min,恢复指数分别为10.0min±1.8min、12.8min±2.4min,两组比较,差异有显著统计学意义(P<0.01);用异丙酚/地氟醚麻醉维持30min、45min、60min,D组罗库溴铵输注速率均小于P组(P<0.01,P<0.05)。结论地氟醚能显著增强罗库溴铵的肌松作用,加快其起效时间,作用时间延长,减小输注速率。

Objective To investigate the effects of desflurane on the dose-response relationship,time-course of action and infusion rate of rocuronium in children.Methods The investigation including three sections,eighty children,3-10 years old,were randomly divided to propofol group(group P)and desflurane group(group D).In group P,children received propofol infusion at a rate of 6 ～ 8 mg.kg-1.h-1.In group D,children received 6% desflurane inhalation.Neuromuscular blockade was evaluated by acceleromyography(TOF-Guard,Denmark).In the first section,the dose-response curves were constructed by two-dose cumulative technique in 20 children each group after 60 min of desflurane or propofol anesthesia.In the second section,the time course of rocuronium action was evaluated in 10 children each group after intravenous bolus administration of rocuronium 600 μg/kg after 60 min of desflurane or propofol anesthesia.In the third section,rocuronium 0.6 mg/kg was administered after induction in 10 children each group.Once the first twitch response(T1)returned to 5%,propofol was infused or desflurane was inhaleded,and muscle relaxation was maintained by continuous infusion of rocuronium,adjusted to maintain a about 90% T1 depression.The infusion rate of rocuronium was recorded every 15 minutes.Results The ED50,ED90 and ED95 of rocuronium in group P and group D were 188.7 μg /kg VS 157.4 μg /kg,316.3 μg /kg VS 263.9 μg /kg,and 366.2 μg /kg VS 305.5 μg /kg,respectively.The onset time,the time from T1 0 % to T1 25 % and recovery index of rocuronium in group P and group D were 83 ± 5 s VS 70 ± 6 s,25 ± 4 min VS 31 ± 3 min,and 10.0 ± 1.8 min VS 12.8 ± 2.4 min respectively.The infusion rate of rocuronium was lower in group D than that in group P after 30,45,60 min of desflurane inhalation or propofol infusion.Conclusion Desflurane can obviously enhance the effect of muscle ralaxation,accelerate the onset time,prolong the recovery time and reduce the infusion rate of rocuronium in children.