舒更葡糖钠与新斯的明拮抗小儿腹腔镜疝修补术后罗库溴铵肌松作用比较

A comparison of sugammadex and neostigmine for reversal of rocuronium‑induced neuromuscular blockade undergoing laparoscopic inguinal hernia repair in children

目的评价舒更葡糖钠和新斯的明用于小儿腹腔镜斜疝修补术后逆转罗库溴铵肌松作用的效果。方法择期全身麻醉下行腹腔镜斜疝修补术患儿40例,ASA分级Ⅰ、Ⅱ级,采用随机数字表法将入选患儿分为舒更葡糖钠组(S组)和新斯的明组(N组),每组20例。静脉注射咪达唑仑、芬太尼、丙泊酚和罗库溴铵行麻醉诱导,术中吸入七氟醚维持。应用加速度肌松监测仪进行四个成串刺激(train of four stimulation,TOF)模式监测肌松情况。术毕当肌松监测T2再现时,S组静脉注射舒更葡糖钠2 mg/kg,N组静脉注射阿托品0.01 mg/kg和新斯的明0.05 mg/kg。记录给予肌松拮抗剂后TOF比值(TOF ratio,TOFR)恢复到0.7、0.8、0.9的时间,拔管时间和PACU滞留时间;记录肌松拮抗前即刻与拮抗后2、5、10、30 min的心率、血压;记录苏醒期疼痛、躁动、恶心、呕吐及寒战的发生情况。结果S组TOFR恢复至0.7、0.8、0.9的时间及拔管时间均较N组明显缩短(P<0.05),但两组PACU滞留时间差异无统计学意义(P>0.05)。N组患儿肌松拮抗2、5、10 min后的心率与2、5 min后的血压明显低于S组(P<0.05)。两组患儿苏醒期疼痛、躁动、恶心、呕吐及寒战的发生情况差异无统计学意义(P>0.05)。结论与新斯的明比较,小儿腹腔镜斜疝修补术后使用舒更葡糖钠拮抗罗库溴铵的肌松作用能明显缩短肌松恢复时间与拔管时间。

Objective The present work compared the efficacy of sugammadex and neostigmine on reversing neuromuscular blockade induced by rocuronium in children undergoing laparoscopic inguinal hernia repair.Methods Forty children,American Society of Anesthesiologists(ASA)gradeⅠorⅡ,scheduled for laparoscopic inguinal hernia repair were divided into sugammadex(S)group and neostigmine(N)group(n=20)according to the random number table method.Patients received intravenous midazolam,fentanyl,propofol,and rocuronium for induction,followed by sevoflurane maintained anesthesia.Neuromuscular blockade was monitored for a train of four stimulation(TOF)measurement using acceleromyography.Sugammadex 2.0 mg/kg or neostigmine 0.05 mg/kg and 0.01 mg/kg atropine were administered intravenously in patients of group S or group N,respectively,at the reappearance of the second response of the TOF.The time of TOF ratio(TOFR)recovery to 0.7,0.8,0.9,and the time of extubation and discharging from the post‐anesthesia care unit(PACU)were recorded.Heart rate and blood pressure were recorded before and 2,5,10 min and 30 min after the administration of the reversal agents.The incidences of postoperative pain,agitation,nausea,vomiting and shivering were also recorded in PACU.Results The times to achieve TOFR of 0.7,0.8,0.9 and extubation were significantly shorter in group S(P<0.05),but no significant difference was found in PCAU length of stay between the two groups(P>0.05).The average heart rate at 2,5,10 min after reversal and mean arterial pressure at 2,5 min after reversal were significantly lower in group N than in group S(P<0.05).There was no significant difference in the incidences of postoperative pain,agitation,nausea,vomiting and shivering between the two groups(P>0.05).Conclusions Sugammadex can achieve significantly faster recovery of neuromuscular function after rocuronium and extu‐bation times than neostigmine in pediatric patients undergoing laparoscopic inguinal hernia repair.