新斯的明拮抗小儿和成年患者维库溴铵的残余肌松作用

Antagonize vecuronium-induced residual neuromuscular blockade with neostigmine in pediatric and adult patients

目的观察麻醉恢复期新斯的明拮抗小儿和成年全麻患者维库溴铵的残余肌松作用的剂量反应和安全性。方法全麻下择期手术的小儿和成年患者各50例，维库溴铵首剂0．1mg/kg，术中必要时追加0．05mg/kg。采用加速度肌松监测仪监测四个成串反应的比值（train-of-four ratio，TOFR）。当TOFR恢复至0．55时，小儿和成年患者分别随机分为5个亚组，分别给予新斯的明10、20、30、50μg／kg及阿托品5、10、15、25μg／kg，对照组静脉注射生理盐水2ml。观察TOFR恢复至0．7、0．9、1．0的时间及术后6、24h恶心呕吐的发生情况。结果新斯的明明显加快TOFR的恢复（P〈0．05），其中30μg／kg-50μg/kg效果均更明显（P〈0．05）。小儿和成年患者新斯的明拮抗维库溴铵残余肌松作用的剂量反应曲线的差异无统计学意义（P〉0．05），拮抗5min时，小儿和成年患者新斯的明的ED95分别为（6．4±10．5）μg／kg和（2．7±19．2）μg／kg。术后6、24h恶心呕吐情况的差异无统计学意义（P〉0．05）。结论在TOFR恢复至0．55时，小儿和成年患者新斯的明拮抗维库溴铵的残余肌松作用的效果无统计学差异，推荐使用小剂量的新斯的明进行拮抗，剂量不宜超过30μg／kg。

Objective To study the dose-effect relationships and safety for neostigmine as antagonist of vecuronium-inducted residual neuromuscular blockade in children and adults. Methods The first dose of vecuronium was 0.1 mg/kg, bolus doses of 0.05 mg/kg vecuronium were injected into 50 children and 50 adult patients as clinically needed during surgery. At an acceleromyography train-of-four ratio （TOFR） recovery of 0.55, neostigmine （10, 20, 30 or 50 μg/kg） and atropine （5, 10, 15 or 25 μg/kg） were administrated by random allocation. Group control was administrated saline 2 ml. Time of TOFR recovery of 0.7, 0.9 and 1.0 and complication of postoperative nausea and vomiting （PONV） in 6 and 24 hours were also recorded. Results Neostigmine accelerated the recovery of TOFR. It was significant different that the recovery time of four doses of neostigrnine compared to group control（P〈0.01 ）, especially the dose of 30 μg/kg -50 μg/kg （P〈0.05）. There was no difference in dose-response relationships for neostigmine and the incidence of PONV in 6 hours and 24 hours between pediatric and adult patients（P〉0.05 ）. At the fifth minute after antagonism, ED95 of neostigmine was（6.4 ± 10.5 ） μg/kg and（2.7±19.2） μg/kg respectively in children and adult patients. Conclusion Different doses of neostigmine are equally effective against vecuronium in children and adult patients at TOFR recovery of 0.55. Low dose of neostigmine, no more than 30 μg/kg, is suitable for antagonizing residual neuromuscular blockade.