紫绀型与非紫绀型先天性心脏病对罗库溴铵起效和作用时间的影响

Comparison of pharmocodynamics of rocuronium between congenital heart disease and normal children

目的 探讨先天性心脏病患儿与正常儿童罗库溴铵药效学的差异，为罗库溴铵在临床小儿心脏手术中的合理应用提供理论依据。方法选择ASAⅡ～Ⅲ，年龄6～12岁先天性心脏痛心内分流患儿30例，分为非紫绀型（n=15）和紫绀型（n=15）两组。另择拟行择期手术的非心脏病患儿15例（对照组）。麻醉诱导后，给予单次剂量罗库溴铵600μg／kg。采用TOF—Watch SX加速度肌松监测仪监测肌松，记录3组患儿患儿罗库溴铵的起效时间、作用时间、恢复状况及相关指标。结果非紫绀组、紫绀组、对照组患儿罗库溴铵的起效时间、临床作用时间、肌松恢复时间和恢复指数分别为（3．2±1．3）min、（22．8±5．1）min、（39．1±3．5）min、（16．4±4．2）min；（4．1±2．5）min、（23．4±3．2）min、（41．0±2．2）min、（17．2±4．5）min和（2．4±1．6）min、（25．3±3．5）min、（40．8±5．0）min、（15．9±1．9）min。3组起效时间的比较有统计学差异（P〈0．05），但三组罗库溴铵的临床作用时间、肌松恢复时间、恢复指数等数据的比较均无统计学意义（P≥0．05）。结论无论紫绀型或非紫绀型先心病心内分流均会延长罗库溴铵的起效时间并可能干扰肌松作用及恢复时间。临床上针对此类病人，应完善肌松监测。

Objective To evaluate the different pharmacodynamic between congenital heart disease and normal children. Methods There were 45 patients aged 6-12 yr involved in the present study, including 15 cases with normal cardiac function, 15 cases with acyanotic congenital heart disease and 15 with cyanotic congenital heart disease. After anesthesia was induced, a bolus dose of rocuronium 600μg/kg was administered to the patients. The onset time, clinic duration and recover time were observed. Results Children with normal cardiac function demonstrated a shorter onset time than children with intracardiac shunts （P〈0.05）. There was statistically significant difference between the acyanotic and cyanotic patients （P〈0.05）. However, the clinic duration, recover time and recovery index in the 3 group were no statistically significant difference （P〉0. 05）. Conclusions These results confirm that the clinical onset of relaxation is delayed and spontaneous recovery may be interfered in children with intracardiac shunts.