顺式阿曲库铵在小儿心脏外科快通道麻醉中的应用

The application of cisatracurium in children during fast-track cardiac anesthesia

目的回顾性分析顺式阿曲库铵在小儿心脏外科快通道麻醉中的应用,以期指导肌松药的临床使用。方法调取2012年3~8月在本院实施快通道麻醉的309例心脏外科手术患儿的病历资料。其中165例患儿麻醉中使用顺式阿曲库铵作为肌松药（T组）,144例患儿使用罗库溴铵作为肌松药（C组）。比较两组患儿芬太尼使用剂量、体外循环时间、手术时间、术后机械通气时间、术后重症监护室停留时间等临床数据。结果患儿的性别、年龄、体重、体外循环时间、手术时间、术后机械通气时间、术后重症监护室停留时间等资料,组间差异无显著性（P〉0.05）。T组患儿手术中芬太尼用量高于C组（P=0.000）,而肌松药停药距手术结束时间短于C组（P=0.000）。两组患儿气管导管拔除后均未发生再次气管内插管。结论与罗库溴铵相比,使用顺式阿曲库铵作为肌松药时,小儿心脏外科快通道麻醉中镇痛药芬太尼剂量范围更宽,肌松药可以更晚停药,但手术后机械通气时间和重症监护室停留时间不会延长。在小儿心脏外科快通道麻醉中使用顺式阿曲库铵作为肌松药是安全可行的。

Objective To analyze the application of cisatracurium in children during fast-track cardiac anesthesia retrospectively. In order to guide the clinical use of muscle relaxants. Method Medical records of 309 children undergoing fast-track cardiac anesthesia in our hospital from Mar.2012 to Aug.2012 were taken. Cisatracurium was used as the muscle relaxant in 165 children（Group T）, and rocuronium was used as the muscle relaxant in the other 144 children（Group C）. The clinical data about the dose of fentanyl, the duration of cardiopulmonary bypass, the duration of operation, the duration of post-operative mechanical ventilation and the duration of postoperative intensive care unit（ICU） stay were compared between the two group. Result There was no statistical difference in sex, age, weight, the duration of cardiopulmonary bypass, the duration of operation, the duration of post-operative mechanical ventilation and the duration of post-operative ICU stay between the two groups（P〉0.05）. Compared with group C, the dose of fentanyl was higher in group T during operations（P=0.000）, and the time interval between the muscle relaxant withdrawal and the end of operation was shorter in group T（P=0.000）. There was no re-intubation in both groups after extubation. Conclusion Compared with rocuronium, the muscle relaxant withdrawal can be later and the dose of fentanyl can be higher in children received cisatracurium during fast-track cardiac anesthesia, without prolonging the duration of post-operative mechanical ventilation and post-operative ICU stay. The application of cisatracurium in children during fast-track cardiac anesthesia is safe and effective.