七氟醚吸入不同时间对患儿顺式阿曲库铵肌松效应的影响

Influence of Different Duration of Sevoflurane Inhalation on the Muscle Relaxation Effect of Cisatracurium in Children

目的:探讨七氟醚吸入时间对患儿顺式阿曲库铵肌松效应的影响。方法:择期行颜面、颈部手术(唇裂修复术、腭裂修复术和甲舌囊肿切除术)的患儿60例,美国麻醉师协会(ASA)分级Ⅰ或Ⅱ级,年龄2～8岁,按用药情况分为吸入七氟醚30min组(S30组)、吸入七氟醚60min组(S60组)和全凭静脉麻醉组(T组),各20例。麻醉诱导后,静脉注射顺式阿曲库铵0.15mg·kg-1,S30组和S60组插管后即刻吸入七氟醚,维持呼气末浓度2.5%,分别吸入30min和60min;T组全凭静脉麻醉。行连续4个成串刺激(TOF)方式,采用肌松监测仪监测拇内收肌的肌松情况。记录肌松起效时间(Tonset)、最大效应持续时间(DURp)、临床作用时间(DURc)、恢复指数(RI)、体内作用时间(DURt)及TOFR(T4/T1)恢复至90%的时间(TOFR0.9)。结果:3组Tonset比较差异无统计学意义(P>0.05);与T组比较,S30组和S60组DURp、DURc、TOFR0.9延长,S60组DURt、RI延长(P<0.05);与S30组比较,S60组DURp、DURc、DURt和TOFR0.9延长(P<0.05)。结论:2.5%七氟醚可增强患儿顺式阿曲库铵的肌松效应,且随吸入时间延长而增强,持续吸入60min可延迟自然恢复,吸入时间不超过30min则不会。

OBJECTIVE：To investigate the influence of different duration of sevoflurane inhalation on muscle relaxation effect of cisatracurium in children.METHODS：60 children （2～8 years old,ASAⅠ～Ⅱ） undergoing elective facial and neck surgery （cheiloplasty,palatorrhaphy and thyroglossal duct cyst excision） were divided into 30-min sevoflurane inhalation group （group S30）,60-min sevoflurane inhalation group （group S60） and total intravenous anesthesia group （group T） with 20 children in each group,according to drug use.After anesthesia,they were given intravenous injection of cisatracurium 0.15 mg·kg-1,and group S30 and S60 were exposed to 2.5% sevoflurane after tracheal intubation for 30 min and 60 min while group T received total intravenous anesthesia.Those groups received a train-of-four （TOF） mode,and muscle relaxation monitor was used to monitor the muscle relaxation.Onset time （Tonset）,duration of peak effect（DURp）,recovery index（RI）,duration of clinical action（DURc）,duration of total action （DURt） and time to TOFR（T4/T1） 90% （TOFR0.9） were recorded.RESULTS：There was no signi？cant difference in Tonset among the three groups （P〉0.05）.DURp,DURc and TOFR0.9 of group S30 and group S60 were significantly prolonged compared to group T （P〈0.05）.DURp,DURc,DURt and TOFR0.9 of group S60 were significantly prolonged compared to group S30 （P〈0.05）.CONCLUSION：2.5% sevoflurane can enhance the muscle relaxation effect of cisatracurium in children with increasing durations of inhalation.60 min of sevoflurane inhalation may delay the spontaneous recovery,while 30 min or less of sevoflurane inhalation may not.