米库氯铵与顺苯磺酸阿曲库铵在婴幼儿唇腭裂手术中的应用比较

A comparison of effect of mivacurium and cistracurium in infants undergoing cleft lip and cleft palate surgery

目的观察和比较米库氯铵和顺苯磺酸阿曲库铵用于婴幼儿唇腭裂手术中的肌松效应和安全性。方法 2012年9月至2013年9月择期行唇腭裂手术治疗的患儿60例,年龄6个月至3岁,随机分为两组,每组30例。两组均给予咪达唑仑0.1mg/kg、丙泊酚2mg/kg、瑞芬太尼1μg/kg及米库氯铵0.2mg/kg(M组)或顺苯磺酸阿曲库铵0.15mg/kg(C组)行麻醉诱导后气管插管。采用TOF-Guard加速度肌松监测仪连续监测尺神经四个成串刺激(TOF)。观察并记录肌松起效时间、临床作用时间和恢复指数,进行插管评级并观察不良反应情况。结果两组的插管条件评级差异无统计学意义。M组肌松起效时间、肌松临床作用时间以及恢复指数明显短于C组(P<0.05);M组不良反应发生率明显低于C组(P<0.05)。结论米库氯铵用于婴幼儿唇腭裂手术时起效快、肌松效应时间短,恢复较快。

Objective To compare the effect of mivacurium and cistracurium in infants undergoing cleft lip and cleft palate surgery with general anesthesia.Methods Sixty infants with ASA Ⅰ orⅡ undergoing cleft lip and cleft palate surgery from September 2012 to September 2013 were randomly divided into two groups（n=30cases each）.All patients were given midazolam 0.1mg/kg,propofol 2mg/kg,remifentanil 1μg/kg.The infants in group M were anesthesized with mivacurium（0.2mg/kg）and those in group C were anesthesized with cistracurium（0.15mg/kg）for tracheal intubation.The response of ulnar nerve to train-of-four stimulation was monitored with TOF-Guard SX muscle relaxtion monitor,and the onset time,clinical duration,recovery index and intubation grades were recorded.Results No statistically significant differences between two groups of intubation grades.The onset time,clinical duration and recovery index in group M was significantly shorter than that in group C（P〈0.05）.The incidene of adverse reaction in group M was significantly lower that in group C（P〈0.05）.Conclusion Mivacurium is an effective and safe musle relaxant in infants undergoing cleft lip and cleft palate with general anesthesia.It is suitable for general anesthesia intubation.