摘要
目的比较新生儿、婴儿、幼儿和儿童应用新斯的明拮抗罗库溴铵的效果。方法选择2014年7月至2015年4月于天津市儿童医院住院行择期全麻手术患儿160例，美国麻醉医师协会（ASA）病情分级Ⅰ或Ⅱ级，根据年龄分为新生儿组、婴儿组、幼儿组及儿童组，再将各年龄组患儿采用随机数字表法随机分为对照组和拮抗组，每组各20例。麻醉诱导后，给予患儿罗库溴铵首剂量0．6mg／kg，术中必要时追加罗库溴铵0．2mg／kg，采用加速度肌松监测仪监测4个成串反应（TOF），术毕当TOF逐渐恢复至肌颤搐幅度（T1）达到对照值15％时，拮抗组给予静脉注射新斯的明0．03mg／kg及阿托品0．01mg／kg，而对照组给予静脉注射生理盐水0．1ml／kg，观察并记录从给予新斯的明或生理盐水后T1恢复至25％（T25）、75％（T75）、TOF第4个肌颤搐与第1个肌颤搐的比值（T4／T1）=0．7（TR0.7）恢复时间、恢复指数及拮抗前后患儿平均血压（SBP）、心率（HR）等血流动力学变化，观察拮抗后患儿有无心率减慢、大汗、流涎及术后24h内恶心呕吐等不良反应。结果在对照组患儿中，新生儿组、婴儿组、幼儿组、儿童组的T25恢复时间分别为（27．10±8．72）、（16．70±6．35）、（13．05±1．96）、（14．40±3．08）min，差异有统计学意义（F=25．052，P〈0．01）；TR0.7恢复时间分别为（27．75±8．56）、（18．45±5．62）、（14．95±2．64）、（15．70±3．36）min，差异有统计学意义（F=22．496，P〈0．01）；恢复指数分别为（20．75±7．09）、（12．40±5．04）、（10．01±2．00）、（10．55±2．82）min，差异有统计学意义（F=22．725，P〈0．01）；新生儿组的T75恢复时间、TR0.7恢复时间及恢复指数高于婴儿、幼儿、儿童组（均P〈0．01），而婴儿、幼儿及儿童组间各项恢复指标差异均无统计学意义（均P〉0．05）。在新斯的明拮抗组中，新生儿组、婴儿组、幼儿组、儿童组的T75恢复时间分别为（14．05±3．54）、（8．08±3．08）、（6．53±0．98）、（7．10±1．54）min，差异有统计学意义（F=37．947，P〈0．01）；TR0.7恢复时间分别为（14．95±3．19）、（9．32±3．44）、（7．45±1．40）、（8．12±1．67）min，差异有统计学意义（F=34．744，P〈0．01）；恢复指数分别为（11．05±3．26）、（5．96±2．46）、（4．99±0．95）、（5．22±1．39）min，差异有统计学意义（F=33．542，P〈0．01）；新生儿组的T75恢复时间、TR0.7恢复时间及恢复指数均高于其他年龄组患儿（均P〈0．01）。各组患儿拮抗前后血液动力学稳定，无明显不良反应。结论婴儿、幼儿及儿童应用罗库溴铵后，其自然恢复时程相同；所有年龄组患儿新斯的明拮抗罗库溴铵的逆转效果明显；但新生儿的罗库溴铵自然恢复时间或新斯的明拮抗后逆转恢复时间均多于其他年龄组患儿。
Objective To compare the effectiveness of neostigrnine induced reversal of rocuronium in neonates,infants, young children and children. Methods One hundred and sixty ASA Ⅰ or Ⅱ pediatric patients undergoings elective surgical procedures under total intravenous anesthesia were enrolled during July 2014 to April 2015 in Tianjin Children＇s Hospital. The patients were divided into four groups according to ages： neonate group, infant group, young children group and children group. Then control subgroup and neostigmine reversal subgroup including twenty patients were randomly selected from every different age groups by the method of random number table. After induction of anesthesia, 0. 6 mg/kg rocuronium was administered, and 0. 2 mg/kg maintenance doses given as required during period of operation.Neuromuscular block was monitored using acceleromyographic train of four （TOF）. When T1/control returned to 15% , 0. 03 mg/kg neostigmine and 0.01 mg/kg atropine were given to patients of reversal subgroups, and saline 0. 1 mL/kg was given to patients of control subgroups. The recovery time of T25 ,T75, TR0.7, recovery index , blood pressure, heart rate and adverse reactions were observed and recorded. Results In control subgroups, the recovery time of T75 for neonates , infants, young children and children were （27. 10 ± 8.72 ）, （ 16. 70 ± 6.35 ）, （ 13.05 ± 1.96 ）, （ 14.40 ±3.08 ） rain, respectively （ F = 25. 052, P 〈 0. 01）. The recovery time of TR0.7 were （27. 75 ±8. 56）, （ 18. 45 ± 5.62） , （ 14. 95 ± 2. 64） , （ 15.70 ± 3.36） rain, respectively （ F = 22. 496, P 〈 0. 01 ） . The recovery index were （ 20. 75 _± 7.09 ） , （ 12.40± 5.04）,（10.01 ± 2.00）, （10.55 ±2.82） min, respectively（F = 22. 725,P 〈 0.01）.There were no significant difference for the every recovery time and recovery index between infants, young children and children （ all P 〉 0.05 ） . But the recovery time of T75, TR0. 7 and recovery index in neonate group were longer than other age groups （ all P 〈 0. 01 ）, In reversal subgroups , the recovery time of T75 for neonates , infants, young children and children were （ 14. 05 ± 3.54）, （ 8.08± 3.08 ）, （ 6. 53± 0. 98 ）, （7.10 ± 1.54） min,respectively（F = 37. 947, P 〈 0. 01 ） . The recovery time of TR0.7 were （ 14. 95±3.19） , （9. 32± 3.44）, （7.45 ± 1.40）, （8. 12 ±1.67） min, respectively （F = 34. 744,P 〈0. 01 ）. The recovery index were （11.05±3.26）,（5.96 ±2.46）,（4.99 ±0.95）,（5.22± 1.39）min ,respectively（F=33.542,P〈 0.01 ）. The recovery time of T75 ,TR0.7 and recovery index were delayed in neonates compared with other age groups （all P 〈0, 01 ）. Haemodynamies were stable in all groups before or after giving antagonist,and no significant adverse reactions were observed. Conclusions The spontaneous recovery time after administrating roeuroniurn are comparable in infant, young children and children. There are obviously reversal effects in all o（ age groups when neostigmine is given to antagonize rocuronium. Either spontaneous recovery time or reversal recovery time of neostigmine to rocuronium is longer for neonates than other age＇s children.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2016年第10期807-811,共5页
National Medical Journal of China
