芬太尼和咪达唑仑给药顺序对小儿麻醉诱导期依托咪酯所致肌阵挛的影响

Midazolam and fentanyl reduce etomidate-induced myoclonus in children

目的观察芬太尼和咪达唑仑在麻醉诱导期间不同给药顺序对防治小儿依托咪酯引起肌阵挛的效果。方法拟在气管插管全身麻醉下择期行腺样体吸割术的患儿80例,年龄≥2岁,美国麻醉医师学会(ASA)分级Ⅰ或Ⅱ级。麻醉诱导药物:静脉注射咪达唑仑0.1mg/kg(最大剂量3mg)、芬太尼2μg/kg、依托咪酯0.3mg/kg(乳剂,江苏恩华药业),随后予顺式阿曲库铵0.1mg/kg,肌肉松弛达最大阻滞时行气管插管。根据麻醉诱导给药顺序将80例患儿随机分入依咪芬组(依次静脉注射依托咪酯、咪达唑仑、芬太尼)、芬依咪组(依次静脉注射芬太尼、依托咪酯、咪达唑仑)、咪依芬组(依次静脉注射咪达唑仑、依托咪酯、芬太尼)和咪芬依组(依次静脉注射咪达唑仑、芬太尼、依托咪酯),每组20例。静脉注射依托咪酯后1min内观察肌阵挛发生情况并评分,之后依次注射余下药物。结果依咪芬组的肌阵挛发生率显著高于其他3组(P值均<0.05),肌阵挛分级1、2、3级的构成比亦显著高于其他3组(P值均<0.05)。芬依咪组与咪依芬组间肌阵挛发生率和肌阵挛分级构成的差异均无统计学意义(P值均>0.05);咪芬依组肌阵挛发生率显著低于咪依芬组和芬依咪组(P值均<0.05),肌阵挛分级1、2、3级的构成比亦显著低于咪依芬组和芬依咪组(P值均<0.05)。结论预先使用咪达唑仑或芬太尼均可有效减少小儿麻醉诱导期依托咪酯引起的肌阵挛发生,而两药联合应用可取得更好的效果。

Objective To investigate the effect of midazolam and fentanyl on etomidate-induced myoclonus in children. Methods Eighty children （age^2 years, American Society of Anesthesiologists [-ASA（ I - Ⅱ ） who were to undergo obstructive sleep apnea hypopnea syndrome （OSAHS） surgery, were randomly divided into four groups according to the sequence of using anesthetics during anesthesia induction. The dosage of three anesthetics was as follows., midazolam 0. 1 mg/kg, fentanyl 2 pg/kg, and etomidate 0.3 mg/kg. Group D （etomidate, midazolam and fentanyl）, group M （midazolam, etomidate and fentanyl）, group F （fentanyl, etomidate and midazolam）, and group H （fentanyl, midazolam and etomidate）. The incidence of myoclonus was observed 1 minute after injection of etomidate. After anesthesia induction, cisatracurium 0. 1 mg/kg was given, and endotracheal intubation was performed when the muscle was relaxed totally. Results The incidence of myoclenus in group D was significantly higher those than in the other three groups （all P^0.05）, and the patients with myoclonus scale 1 -- 3 in group D were much more than the other three groups （all P^0.05）. There were no significant differences in the incidence or grading of myoclonus between group F and group M （all P^0.05）. The incidence of myoclonus in group H was significantly lower than those in group F and group M （both P〈0.05）, and the patients with myoclonus scale 1 - 3 in group H were less than group F and group M （all P〈0.05）. Conclusion Both midazolam and fentanyl can effectively reduce etomidate-induced myoclonus in children, and combination of the two drugs can achieve better effect.