婴幼儿心脏手术快通道麻醉中肌松药的选择和使用

The selection and application of muscle relaxants in infants during fast-track cardiac anesthesia

目的探讨三种不同肌松药在婴幼儿心脏手术快通道麻醉中的选择和使用。方法回顾性分析2012年3~8月心脏手术快通道麻醉婴幼儿(1个月<年龄<4岁)的病例资料,按手术中肌松药的使用分为罗库溴铵组(L组)、哌库溴铵组(P组)和顺式阿曲库铵组(S组)。心脏手术快通道麻醉婴幼儿共332例,其中L组124例,P组75例,S组133例,比较三组患者术中镇痛药和肌松药剂量、拔除气管导管与停麻醉药的时间间隔等数据并进行统计分析。结果三组患者术中肌松药使用剂量分别为:L组(2.90±1.15)mg/kg,P组(0.30±0.10)mg/kg,S组(1.00±0.68)mg/kg。与L组和P组相比,S组患者术中使用了更大剂量的芬太尼(P=0.000),但拔管与停用肌松药的时间间隔更短(P=0.000)。与L组和S组相比,P组患者拔管与停用芬太尼的时间间隔更长(P=0.023)。三组患者拔除气管导管后均未发生再次气管内插管。结论罗库溴铵、哌库溴铵和顺式阿曲库铵均可用于婴幼儿心脏手术快通道麻醉。应掌握不同肌松药的使用剂量和停药时机,并在术中合理使用镇痛药物。

Objective To discuss the selection and application of three different muscle relaxants in infants during fast-track cardiac anesthesia. Method Medical records of infants （1 month〈age〈4 years） undergoing fast-track cardiac anesthesia in our hospital from Mar. 2012 to Aug. 2012 were selected. The infants were divided into rocuronium group （group L）, pipecuronium group （group P） and cisatracurium group （group S）. There were 332 infants received fast-track cardiac anesthesia. 124 of them were in group L, 75 of them were in group P, while the remaining 133 were in the group S. The doses of fentanyl and muscle relaxants, the time intervals between anesthetic withdrawal and extubation were extracted for comparisons between groups and statistical analysis. Result The doses of muscle relaxants （mg/kg） were （2.90±1.15） in group L, （0.30±0.10） in group P, and （1.00±0.68） in group S. Compared with group L and group P, the doses of fentanyl were higher in group S intra-operatively （P=0.000）, but the time intervals between the muscle relaxant withdrawal and extubation were shorter （P=0.000）. Compared with group L and group S, the time intervals between the fentanyl withdrawal and extubation were longer in group P （P=0.023）. There was no re-intubation in the three groups after extubation. Conclusion Rocuronium, pipecuronium and cisatracurium can be chosen as the muscle relaxants in infants during fast-track cardiac anesthesia. We should grasp the doses of muscle relaxants and the time intervals between the muscle relaxant withdrawal and extubation. And we should use fentanyl properly as well.