顺式阿曲库铵与维库溴铵对行眼科手术的小儿患者的时效

Time course characteristics of cisatracurium and vecuronium in children undergoing ophthalmologic surgery:a comparative study

目的比较顺式阿曲库铵与维库溴铵复合剂量用于眼科手术小儿患者时神经肌肉阻滞的时效。方法 180例美国麻醉医师学会(ASA)分级Ⅰ～Ⅱ级行眼科斜视矫正术的患儿,随机分为顺式阿曲库铵组和维库溴铵组,每组90例。麻醉诱导:两组分别静脉注射0.15mg/kg顺式阿曲库铵或0.1mg/kg维库溴铵。麻醉维持:T1恢复至25%时两组分别静脉注射0.03mg/kg顺式阿曲库铵、0.02mg/kg维库溴铵。予首次剂量后2min评估插管条件。采用ToF-Guard肌松监测仪对尺神经行连续4个成串(TOF)刺激,监测拇内收肌肌颤搐变化。记录首次给药后肌松持续时间(首次给药到T1恢复至25%的时间),重复给药后的肌松持续时间(重复给药到T1恢复至25%的时间)、最后给药的肌松持续时间(最后给药到T1恢复至25%的时间),自主呼吸完全恢复时间(最后给药到T4/T1=0.8的时间)和肌松恢复指数(自T1恢复至25%到T4/T1=0.8的时间)。结果顺式阿曲库铵组首次给药后肌松持续时间显著长于维库溴铵组(P<0.01),两组重复给药后的肌松持续时间、最后剂量的肌松持续时间、肌松恢复指数、自主呼吸完全恢复时间的差异均无统计学意义(P值均>0.05)。顺式阿曲库铵组≤12个月的患儿首次给药后肌松持续时间显著长于维库溴铵组(P<0.01);顺式阿曲库铵组≤12个月的患儿肌松恢复指数显著短于维库溴铵组(P<0.01)。两种药物都提供了良好的插管条件,差异无统计学意义(P值均>0.05)。结论顺式阿曲库铵的恢复指数明显短于维库溴铵,更适合小儿,尤其是<12个月的行眼科手术的患儿。

Objective To compare the time course characteristics of neuromuscular blockade （NMB） induced by multiple doses of cisatracurium （C） and vecuronium （V） in children undergoing ophthalmologic surgery.Methods Totally 180 ASA Ⅰ-Ⅱ children undergoing squint correction surgery were evenly randomized into 2 groups：the cisatracurium group （C） and the vecuronium group （V）.Muscle relaxation was induced with 0.15 mg/kg C or 0.1 mg/kg V and was maintained with 0.03 mg/kg C or 0.02 mg/kg V at T1 25% recovery.Intubating conditions were assessed at 2 min after the initial dose.Time course of NMB was monitored using accelerography （ToF-Guard） of the adductor pollicis with train-of-four （TOF）.Duration of NMB following the first dose （time from first dose to 25% recovery of T1）,duration of NMB following repeated boluses （time from repeated dose and last dose to 25% recovery of T1）,SCRT （time from last dose to spontaneous complete recovery）,and recovery index （T1 from 25%-75% of T1） were recorded.Results Duration of NMB following first dose was significantly longer in group C than in group V （P0.01）.There were no significant differences in recovery index and NMB durations following repeated boluses,last dose,and SCRT between the two groups （P0.05）.The duration of NMB following first dose in patient younger than 12 months was significantly longer and the recovery index was significantly shorter in group C than in group V （P0.01）.Both drugs could provide good/excellent intubating conditions （P0.05）.Conclusion Recovery index of cisatracurium in subjects younger than 12 months is significantly shorter than that of vecuronium,making cisatracurium more suitable for children undergoing ophthalmologic surgery,especially for those younger than 12 months.（Shanghai Med J,2010,33：335-338）