米库氯铵与顺式阿曲库铵在儿童腺样体手术肌松恢复效率比较

Comparison of muscle relaxation recovery efficacy between micuronium and cis-atracurium in pediatric adenoid surgery

目的 比较米库氯铵与顺式阿曲库铵在儿童腺样体手术肌松恢复效率。方法 选取2021年8月至2022年5月杭州市儿童医院行腺样体切除术的腺样体肥大患儿84例。按随机数字表法分为米库氯铵组38例和顺式阿曲库铵组46例,两组患儿在相同的麻醉诱导及麻醉维持下使用米库氯铵及顺式阿曲库铵为肌肉松弛药物(米库氯铵0.2 mg/kg,顺式阿曲库铵0.1 mg/kg)。观察两组患儿在麻醉诱导前(T_(0))、手术开始(T_(1))、手术结束(T_(2))、拔管(T_(3))、拔管后30 min(T_(4))时点的心率(HR)、脉搏血氧饱和度(SpO_(2))、平均动脉压(MAP)、呼气末二氧化碳分压(PETCO_(2));比较手术结束时间至4个成串刺激模式(TOF)达到0.9的时间、恢复指数(RI)、手术结束至拔管的时间、麻醉后恢复室(PACU)停留时间、拔管时TOF值及肌松残余率;比较两组患儿在围术期不良反应发生情况。结果 两组患儿在T_(0)~T_(4)时点的HR、SpO_(2)、MAP、P_(ET)CO_(2)比较差异均无统计学意义(均P>0.05);米库氯铵组TOF达到0.9的时间、RI、手术结束至拔管的时间、PACU停留时间均明显少于顺式阿曲库铵组(均P<0.05),拔管时的TOF值明显高于顺式阿曲库铵组(P<0.05),同时米库氯铵组的肌松残余率明显低于顺式阿曲库铵组(P<0.05)。两组患儿围术期均无不良反应发生。结论 米库氯铵与顺式阿曲库铵的安全性及肌松效率均满足临床需要,而使用米库氯铵时患儿术后神经肌肉恢复效果优于顺式阿曲库铵,更不容易发生肌松残余效应。

Objective To compare efficacy of muscle relaxation recovery between micuronium and cis-atracurium in pediatric adenoid surgery.Methods A total of 84 children with adenoid hypertrophy undergoing adenidectomy in Hangzhou Children's Hospital from August 2021 to May 2022 were randomly divided into micuronium(n=38)and cis-atracurium(n=46)groups;and the micuronium(0.2 mg/kg)or cis-acraconium(0.1 mg/kg)were used as muscle relaxants under the same induction and maintenance of anesthesia conditions in two groups.The heart rate(HR),oxygen saturation(SpO_(2)),mean arterial pressure(MAP)and partial pressure of end-tidal carbon dioxide(PETCO_(2))before the induction of anesthesia(T_(0)),beginning of operation(T_(1)),end of operation(T_(2)),extubation(T_(3))and 30 min after the extubation(T_(4))were compared between two groups.The time from the end of the operation to the TOF reaching 0.9,recovery index(RI),time to extubation,stay time in PACU after anesthesia,TOF value and myopasone residual rate at extubation,adverse reactionswere were also compared.Results There were no significant differences in HR,SpO_(2),MAP and PETCO_(2) at time points T_(0)-T_(4) between two groups(all P>0.05).The time from the end of the operation to the TOF reaching 0.9,RI,time to extubation,and PACU time in micuronium group were significantly lower than those in cis-acracurium group(all P<0.05).The TOF in micuronium group was significantly higher than that in cis-atracurium group(P<0.05).The myopasone residual rate in micuronium group was significantly lower than that in cis-atracurium group(P<0.05).Conclusion Both micuronium and cis-atracurium meet the clinical needs,while the residual neuromuscle block of micuronium is less likely to occur.