全凭静脉麻醉下儿童单次气管插管剂量顺式阿曲库铵的药效学及性别差异

Preliminary study on pharmacodynamics and gender differences after a single intubation dose of cisatracurium under total intravenous anesthesia in children

目的研究全凭静脉麻醉下儿童单次气管插管剂量国产顺式阿曲库铵的肌肉松弛效应,以及性别差异的影响。方法气管插管全凭静脉麻醉下行择期颜面部手术的2～8岁患儿52例,男、女各26例。全凭静脉麻醉,单次静脉注射3×95%的有效药物剂量(ED95,0.15mg/kg)国产顺式阿曲库铵,观察气管插管条件,采用肌肉松弛监测仪对尺神经进行连续4个成串刺激(TOF),观察拇内收肌的加速度变化。记录起效时间、最大效应持续时间、临床作用时间、恢复指数、体内作用时间及TOF比值(第4个肌颤搐反应高度与第1个肌颤搐反应高度的比值)恢复到70%的时间(TOFR0.7)。结果全部患儿气管插管条件评估分级均为Ⅰ级。男女患儿间起效时间、最大抑制持续时间、临床作用时间、恢复指数、体内作用时间及TOFR0.7的差异均无统计学意义(P值均>0.05)。结论 3×ED95顺式阿曲库铵应用于患儿可获得满意的气管插管条件,且男女患儿间单次气管插管剂量肌肉松弛效应无明显差异。

Objective To investigate the pharmacodynamics after a single intubation dose of cisatracurium under total intravenous anesthesia（TIVA） in children and gender differences in drug effects. Methods A total of 52 children（2-8 years old,26 boys and 26 girls） scheduled for elective operation on face under TIVA were enrolled in this study.No volatile anesthetic agent was used.The children received a single bolus of cisatracurium（3×effective dose to produce 95%,0.15 mg/kg）.The conditions for tracheal intubation were evaluated.Neuromuscular block was assessed by monitoring the electromyographic response of the adductor pollicis to supramaximal train-of-four（TOF） stimulation with TOF-Watch SX accelerometry.Onset time,duration of peak effect,duration of clinical effect,recovery index,duration of total effect and time to TOFR（T4/T1） 70% were recorded. Results The conditions of tracheal intubation ranked grade Ⅰ in all the patients.There were no significant differences in the onset time,duration of peak effect,duration of clinical effect,recovery index,duration of total effect or time to TOFR 70% between boys and girls（all P0.05）. Conclusion The tracheal intubation condition is satisfactory after application of 3×ED95 cisatracurium in children.There are no gender differences in pharmacodynamics of a single bolus of cisatracurium.