婴幼儿七氟烷麻醉时使用不同剂量美维松的比较

Clinical Comparison of Neuromuscular Pharmacodynamics of Different Dosage of Mivacurium Chloride in Infants during Sevoflurane Anesthesia

目的研究不同剂量美维松对七氟烷麻醉患儿肌松效应及术后恢复的临床药效学指标.方法 40例ASA分级Ⅰ级拟行全麻患儿按美维松用量随机分为2组,A组:200μg/kg;B组:250μg/kg,每组20例.同时测定拇内收肌对4个成串刺激(TOF)反应的T4/T1值,明确不同剂量美维松肌松作用起效时间,同时比较两组自主呼吸恢复时间和心血管反应.结果 B组的起效时间和达峰效应时间均短于A组(P<0.05),2组的恢复时间没有显著差异无统计学意义(P>0.05).B组注药后2 min舒张压明显低于注药前和A组,注药后3 min收缩压明显低于注药前和A组.结论在婴幼儿七氟烷麻醉时,如果使用大剂量美维松(250μg/kg)可以缩短起效时间,但伴随严重的循环抑制.

Objective To investigate the neuromuscular blocking effects and clinical pharmacology of different dosage of mivacurium chloride in infants during sevoflurane anesthesia. Methods Forty ASA I infants undergoing sevoflurane general anesthesia were randomly assigned to tow groups according to the dose level of mivaeurium： group1：200 μg/kg （n =20） and group2：250 μg/kg （n =20） TOFs were determined synchronously. The onset time of mivacurium, recovery time of spontaneous breathing and cardiovascular reactions were measured. Results The onset time was significantly shortened in group 2 compared with group 1 （P〈0.05） . There was no significant difference in the recovery time of spontaneous breathing between the two groups. 2 minutes after mivacurium was injected, DBP in group 2 decreased significantly compared with baseline and group 1. 3 minutes after mivacurium was injected, SBP in group 2 decreased significantly compared with baseline and group 1. Conclusion In infants undergoing sevoflurane general anesthesia, the onset time of mivacurium can be shortened when 250 μg/kg was administered, but the depression of cardiovascular system may occurr simultaneously.