不同剂量米库氯铵用于喉罩置入的临床观察

Clinical Observation of Different Mivacurium Dosages for Laryngeal Mask Airway Insertion

目的观察不同剂量米库氯铵用于喉罩置入时的肌松作用、以及对喉罩置入条件、患者血流动力学和术后相关并发症的影响.方法随机将60例患者分为4组,C组(对照组);M1组;M2组和M3组,每组15例.除C组外,实验组(M1、M2和M3组)在30 s内单次注射不同剂量的米库氯铵(分别是0.16 mg/kg,0.20mg/kg和0.25 mg/kg.实验组患者于TOF监测T1=0时放置喉罩.对照组在注药后2 min置入喉罩.记录各组喉罩置入的丙泊酚用量及注药后各时间段的收缩压(SBP)、心率(HR)、脉搏氧饱和度(SpO2)的值;同时记录实验组每个病例注射米库氯铵后肌松作用的起效时间(T1=0),临床作用时间和恢复指数;并就置入条件进行评价.结果 M2组和M3组的肌松起效时间较M1组明显增快,维持时间也比M1组显著延长;M3组的恢复指数显著比M1组延长;注药后1 min、2 min和3 min,C组和M3组的收缩压明显较M1组和M2组降低;C组的丙泊酚用量明显高于其余3组;C组在首次置入喉罩时有呛咳和呃逆发生(4例),追加丙泊酚后成功置入喉罩;M1组有2例出现呃逆,但没有追加丙泊酚;M2组和M3组均一次性置入成功.结论一定剂量的米库氯铵(0.20 mg/kg)有助于改善喉罩置入条件,维持血流动力学的稳定并减少术后相关并发症的发生.

Objective To evaluate the effects of different dosages of mivacurium for laryngeal mask airway（LMA） insertion on muscle relaxants state hemodynamics, respiratory mechanics and complications. Methods Sixty patients were randomly assigned into four groups according to different dosages of mivacurium（n=15） ： group C（control group）,group M1,group M2 and group M3. In group M1,group M2 and group M3,0.16 mg/kg,0.20 mg/kg and 0.25 mg/kg mivacurium was injected,respectively. In group C,there was no mivacurium infused. At the same time,with train-of-four provided by TOF-Guard,when T1 was stabilized at 0, LMA was placed in group M1,M2 and M3. In group C,LMA was placed two minutes after injection propofol. SBP, HR and SPO2 were continuously monitored. The dosage of propofol during induction, the onset time, clinical duration and recovery index of mivacurium were recorded. Conditions for LMA insertion were assessed. Results The onset times of muscle relaxation in group M2 and group M3 were shorter significantly than that in group M1,and the clinical durations in group M2 and group M3 were longer significantly than that in group M1. Compared with group M1,patients in group M3 had longer recovery time. In group C and group M3, SBP were decreased significantly one minute,two minutes and three minutes after injection. The dosage of propofol in group C was higher significantly than other groups. Complications such as bucking, hiccup were recorded in 4 patients of group C. Hiccup was recorded in two patients of group M1. There were no bucking and hiccup recorded in group M2 and M3. Conclusion With the dosage of 0.2 mg/kg, mivacurium could provide good conditions for insertion of LMA, stable hemodynamics and low incidence of postoperative complications.