低温体外循环对婴幼儿顺式阿曲库铵肌松作用的影响

Effect of hypothermic cardiopulmonary bypass on the neuromuscular blocking potency of cisatracurium in infants.

目的探讨低温体外循环（CPB）对婴幼儿顺式阿曲库铵肌松作用的影响。方法选择4个月-3岁先天性心脏病患儿（左向右分流）30例，ASA分级Ⅱ或Ⅲ级。监测四次成串剌激（TOF），全麻诱导给予顺式阿曲库铵0．15mg／kg，肌颤搐反应强度（T1）最大程度抑制时进行气管插管。T1恢复至75％时静脉注射顺式阿曲库铵0．05mg／kg。术中观测患儿红细胞压积（Hct）、pH值及体温等；记录CPB前、CPB中和CPB后三阶段T1分别恢复到10％、25％和75％所需时间（T1 10％、T1 25％、T1 75％）及恢复指数（T1 25％到T1 75％之间的时间）。结果与CPB之前相比，Hct在CPB中和CPB后降低（P〈0．05）；pH值在CPB前、中和后差异无统计学意义（P〉0．05）；CPB中的最低温度低于CPB前（P〈0．05），在CPB后温度与CPB前比较差异无统计学意义（P〉0．05）。低温CPB中顺式阿曲库铵的T1 10％、T1 25％较CPB前延长（P〈0．05）；CPB后顺式阿曲库铵的T1 10％、T1 25％、T1 75％及恢复指数均较CPB前延长（P〈0．05）。结论在婴幼儿低温体外循环中顺式阿曲库铵的作用时间延长、恢复延迟，且在CPB后仍不能恢复至CPB前的水平。

Objective To investigate the influence of hypothermic cardiopulmonary bypass （CPB） on the neuromuscular blocking potency of cisatracurium in infants. Methods Thirty ASA Ⅱ -Ⅲ children with congenital heart disease, aged 4 months to 3 years, were chosen. Train-of-four （TOP） was used for evaluating the potency of neuromuscular block. Cisatracurium （0.15 mg/kg） was administered and then tracheal intubation was performed when T1 was depressed the most. When T1 of TOF ascended to 75% of base line, cisatracurium of 0.05 mg/kg was supplemented. The values of intraoperative hematocrit （Hct）, pH and temperture were recorded. The duration （T1 10%, 25%,75%） and the recovery time （T1 25%-75%） of cisatraeurium were measured and recorded pre-, intra- and post-CPB. Results Compared to that of pre-CPB, the values of Hot were significantly lower than that of intra- and post-CPB （P〈0.05）. There were no statistically significant differences in pH between each two periods of pre-, intra- and post-CPB （P〉0.05）. Minimum temperatures intra-CPB were significantly lower than that of pre-CPB （P〈0.05）. There was no statistically significant differences in temperature between pre-CPB and post-CPB （P〉0.05）. The durations （T1 10%, 25%） of intra-CPB were prolonged compared with those of pre-CPB （P〈0.05）. The durations （T1 10%, 25%, 75%） and the recovery time （T1 25%-75%） of cisatracurium in post-CPB were prolonged compared with those in pre-CPB （P〈0.05）. Condusion Hypothermic cardiopulmonary bypass significantly increased neuromuscular blocking potency of cisatraeurium in infants.