短时效肌松药物米库氯铵在儿科日间手术中的应用

Application of short-acting muscle relaxant micuronium in pediatric day surgery

目的评价在小儿日间手术中米库氯铵与顺苯磺酸阿曲库铵2种肌松药的应用效果。方法选取2018年2月至2020年2月于沈阳二四二医院行小儿扁桃体切除术患者60例,采用随机数字表法分成米库氯铵组(M组)和顺苯磺酸阿曲库铵组(C组),每组各30例。麻醉诱导:M组给予米库氯铵0.2 mg/kg,C组给予顺苯磺酸阿曲库铵0.1 mg/kg。记录患儿入室时(T_(0))、置入气管导管后1 min(T_(1))、3 min(T_(2))及拔出后1 min(T_(3))、3 min(T_(4))的脉搏血氧饱和度(SpO_(2));记录气道峰压(Ppeak)、平均气道压(Pmean)和呼吸末二氧化碳(PETCO_(2));记录肌松起效时间(ThD95)、临床作用时间(TOFR25)、恢复指数(RI);术后需拮抗的患儿人数;手术时长及苏醒时间;记录患儿不良反应的发生情况。结果两组均成功完成手术,M组和C组在T_(0)、T_(1)、T_(2)、T_(3)、T_(4)所记录的SpO_(2)、Ppeak、Pmean、PETCO_(2)差异无统计学意义(P>0.05);M组患儿苏醒时间[(5.53±2.06)min]短于C组苏醒时间[(9.73±2.53)min],差异有统计学意义(P<0.05);M组肌松起效时间为(115.23±31.75)s、临床作用时间为(14.70±3.15)min、恢复指数为(5.57±1.76)min,均短于C组肌松起效时间(191.60±32.88)s、临床作用时间(42.37±4.58)min、恢复指数(11.57±3.35)min,且差异均具有统计学意义(P<0.05);M组2例使用拮抗药物,C组10例使用拮抗药物,差异有统计学意义(P<0.05);两组患儿不良反应差异无统计学意义(P>0.05)。结论米库氯铵与顺苯磺酸阿曲库铵在用于小儿日间手术中通气效果未见明显差异,使用米库氯铵的患儿术后苏醒快,拮抗药物的使用减少,患儿康复加快。

Objective To evaluate the application of muscle relaxant mivacurium chloride and cisatracurium in pediatric day surgery.Methods A total of 60 patients who underwent pediatric tonsillectomy at 242 Hospital of Shenyang from February 2018 to February 2020 were divided into the micuronium group(group M)and the cisatracurium group(Group C)by random number table method,30 children in each group.Anesthesia induction group M was given micuronium 0.2 mg/kg,and group C was given cisatracurium 0.1 mg/kg.Record the pulse blood oxygen saturation(SpO_(2))of the child on entering the room(T_(0)),at 1 min(T_(1))and 3 min(T_(2))after insertion of the tracheal tube,at 1 min(T_(3))and 3 min(T_(4))after removal.Record peak airway pressure(Ppeak),mean airway pressure(Pmean)and end-respiratory carbon dioxide(PETCO_(2)).Record onset time of muscle relaxation(ThD95),clinical action time(TOFR25)and recovery index(RI).The number of children who needed to be antagonized after the operation,the length of the operation and the recovery time,the occurrence of adverse reactions in the children.Results Both groups successfully completed the operation.There was no statistical difference in the SpO_(2),Ppeak,Pmean or PETCO_(2) recorded at T_(0),T_(1),T_(2),T_(3) and T_(4) between the M group and C group(P>0.05);the recovery time of group M[(5.53±2.06)min]was shorter than the recovery time of group C[(9.73±2.53)min],the difference being statistically significant(P<0.05);the onset time of muscle relaxation in group M was(115.23±31.75)s,and the clinical action time was(14.70±3.15)min,recovery index being(5.57±1.76)min,which were shorter than those of group C[muscle relaxation onset time(191.60±32.88)s,clinical action time(42.37±4.58)min,recovery index(11.57±3.35)min],and the difference was statistically significant(P<0.05).Two children in group M used antagonistic drugs,and 10 in group C used antagonistic drugs,and the difference was statistically significant(P<0.05).There was no statistical difference in adverse reactions between the two groups(P>0.05).Conclusion There is no significant difference in the ventilation effect between micuronium and cisatracurium in pediatric day surgery.The children who use micuronium will wake up faster after surgery,the use of antagonistic drugs is reduced,and the recovery of patients is speeded up.