婴幼儿腹腔镜手术中二氧化碳气腹对米库氯铵作用时间的影响

Effect of carbon dioxide pneumoperitoneum on duration of mivacurium in young children undergoing laparoscopic surgery

目的探讨小儿腹腔镜手术二氧化碳CO_2气腹对米库氯铵作用时间的影响。方法选取全身麻醉气管插管下行择期腹股沟疝修补术的61例患儿,随机分为腹腔镜组(31例)和开腹组(30例)。静脉给予丙泊酚2.5 mg/kg、芬太尼2μg/kg及米库氯铵0.2 mg/kg进行麻醉诱导,术中吸入50%一氧化二氮N2O+50%氧气O_2+七氟醚维持麻醉,麻醉深度维持在1.2～1.4 MAC。使用肌松监测仪记录4个成串刺激(TOF);分别记录T_1完全消失时间(Ta)(即肌松药完全起效时间);T_1消失至T_1恢复到对照值25%的时间(Tb)(即肌松药有效作用时间)。检测手术前后24 h血浆胆碱酯酶(CHE)、谷丙转氨酶(ALT)、谷草转氨酶(AST)及总胆红素(TBIL)浓度。结果两组米库氯铵Ta、Tb比较,差异无统计学意义(P>0.05);两组术前、术后24 h的CHE、ALT、AST及TBIL浓度比较,差异无统计学意义(P>0.05)。结论婴幼儿CO_2气腹米库氯铵的完全起效时间和有效作用时间无影响。

Objective To investigate the effect of CO2 pneumoperitoneum on the duration of neuromuscular blockade following a single bolus dose of mivacurium in young children undergoing laparoscopic surgery.Methods Totally 61 cases of children(ASAⅠ,aged 6 months to 3 years)with selective inguinal hernia repair were randomly divided into laparoscopic surgery group(L group,n=31)and conventional open surgery group(O group,n=30).Patients were induced with propofol 2.5 mg/kg,fentanyl 2μg/kg and mivacurium 0.2 mg intravenously.Anaesthesia was maintained with 50%N2O,50%oxygen and sevoflurane to maintain a MAC value in the range of 1.2-1.4 MAC.The time of complete disappearance of T1(Ta)(complete onset time of muscle relaxant)was recorded using TOF stimulation by muscle relaxation monitor;the control time from T1 disappeared to T1 recovery to 25%of the control value(Tb)(effective time of muscle relaxant)were recorded.The levels of plasma cholinesterase(CHE),alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin(TBIL)were measured 24 h before and after operation.Results There were no significant differences in the levels of Ta and Tb between the two groups(P >0.05).There was no significant difference in the levels of CHE,ALT,AST and TBIL between the two groups 24 h before and after operation(P >0.05).Conclusions The carbon dioxide pneumoperitoneum has no effect on the complete onset time or the effective time in young children.