不同剂量罗库溴铵在小儿支气管异物取出术中的临床观察

Clinical observation of different dosages of rocuronium in removal of bronchial foreign body in children

目的研究罗库溴铵应用于可以保证通气的小儿支气管异物取出术麻醉的最佳剂量。方法选择年龄10~18个月,ASAⅠ~Ⅱ级,需行气管异物取出术的患儿90例,随机分为3组,每组30例。按罗库溴铵剂量分为3组:Ⅰ组:0.3 mg/kg,Ⅱ组:0.4 mg/kg,Ⅲ组:0.5 mg/kg。术中连续监测生命体征,记录诱导后(T0)、置镜(T1)、钳取异物(T2)、术毕(T3)等时间点的HR、MAP及SPO 2,起效时间、临床肌松时间、丙泊酚总量及麻醉满意度。结果与Ⅱ组、Ⅲ组比较,T1、T2时间点Ⅰ组患儿HR、MAP增高(P<0.05);与Ⅰ组比较,Ⅱ组与Ⅲ组起效时间明显增快(P<0.05);与Ⅱ组比较,Ⅲ组起效时间增快(P<0.05)。与Ⅰ组及Ⅱ组比较,Ⅲ组临床肌松时间明显延长(P<0.05);与Ⅰ组比较,Ⅱ组及Ⅲ组丙泊酚总量减少,镜检满意度增高(P<0.05)。结论小剂量罗库溴铵0.4 mg/kg应用于可以保证通气的小儿支气管异物取出术,配合高频呼吸机控制通气,具有麻醉深度适合、不良反应较少、苏醒迅速及满意度高的特点,是较为理想的麻醉方式。

Objective To investigate the optimal dosage of rocuronium to ensure ventilation in removal of bronchial foreign body in children.Methods Ninety children with ASAⅠ~Ⅱaged 10~18 months who underwent removal of bronchial foreign body were randomly divided into three groups according to the dose of rocuronium:groupⅠ:0.3mg/kg,groupⅡ:0.4mg/kg,groupⅢ:0.5mg/kg,with 30 cases in each group.During the operation,vital signs were continuously monitored,and HR and SPO 2 were recorded after induction of anesthesia(T0),inserting rigid bronchoscopy(T1),removal of foreign body(T2),and at the end of operation(T3),moreover,the onset time of muscle relaxation,clinical duration of muscle relaxation time,total amount of propofol and anesthesia satisfaction extent were observed and compared among the three groups.Results The HR and MAP in groupⅠat T1,T2 were significantly higher than those in groupⅡand groupⅢ(P<0.05).As compared with that in groupⅠ,the onset time of muscle relaxation in groupⅡand groupⅢwas significantly shortened(P<0.05).As compared with that in groupⅠand groupⅠ,the clinical duration of muscle relaxation in groupⅢwas significantly prolonged(P<0.05).As compared with that in groupⅠ,the total amount of propofol in groupⅡandⅢgroup was significantly decreased,with better microscopy satisfaction extent(P<0.05).Conclusion The low dose rocuronium(0.4mg/kg)with high-frequency ventilator to control ventilation applied in pediatric bronchial foreign body removal surgery is an ideal anesthesia method,which has the advantages of appropriate depth of anesthesia,fewer adverse reactions,rapid recovery and higher anesthesia satisfaction degree.