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罗库溴铵预注和麻黄碱预处理对小儿罗库溴铵肌松起效的影响
| Objective The aim of this study was to evaluate the effects of rocuronium priming, ephedrine pretreatment and rocuronium priming combined with ephedrine pretreatment on the onset time of rocuronium, intubating conditions and time-course in children. Methods Eighty children ASAⅠ-Ⅱ, scheduled for elective surgery were randomly allocated to four groups (n=20). Just before induction the children were injected with saline 0.5ml in groupⅠ, rocuronium 0.06mg•kg-1 in groupⅡ, ephedrine 70µg•kg-1 in group Ⅲ, rocuronium 0.06mg•kg-1 and ephedrine 70µg•kg-1 in group Ⅳ. Followed a four minutes priming or/and pretreatment interval, the intubation dose of rocuronium were injected, rocuronium 0.6mg•kg-1 in groupⅠand group Ⅲ, rocuronium 0.54mg•kg-1 in groupⅡ and group Ⅳ. The neuromuscular block was monitored by acceleromyography (TOF-Watch SX, Organon) by using train-of four stimulation every 15s. Endotracheal intubation was performed by a blinded investigator immediately after twitch depressed to the maximum extent. Time of twitch depressed 75%, 90% and the maximum extent were recorded. Intubating conditions were assessed, heart rate and blood pressure were observed as hemodynamic effects in all patients. Results The onset time in groupⅠ,Ⅱ, Ⅲ and Ⅳ was 196±43, 140±43, 144±35, (100±33)seconds. The onset time of rocuronium in groupⅡ, Ⅲ and Ⅳ was significantly shorter than groupⅠ(P<0.05). The onset time of rocuronium in group Ⅳ was faster than in groupⅡand group Ⅲ (P<0.05). The intubating conditions were scored 8-10, and rate of good to excellence was 100% in all groups. There were no significant changes on hemodynamic effects during induction in all patients. Conclusion Either rocuronium priming or ephedrine pretreatment can shorten the onset time of rocuronium. The combination of rocuronium priming with ephedrine pretreatment accelerates the onset of rocuronium, and has no effects on the time-course of rocuronium. 【Key words】 Priming principle; Pretreatment; Rocuronium; Ephedrine; Onset time 预注法和麻黄碱预处理可加快肌松药的起效时间[1]，但存在争议，而且小儿在这方面的报道较少。本研究拟观察在小儿罗库溴铵预注、麻黄碱预处理及预注法复合麻黄碱预处理对罗库溴铵起效时间、插管条件和肌松时效的影响，为临床合理使用肌松药提供临床依据。 资料与方法 一般资料 选择ASAⅠ～Ⅱ级择期手术患儿80例，年龄2～14岁，体重10～57 kg，身高82～162 cm，其中五官科手术 64 例，骨科手术 12例，眼科手术3例，普外科手术1例，。全部病例术前无严重心肺肝肾功能不全、内分泌失调及神经肌肉传导疾病。 病人分组和麻醉诱导 80例患儿随机分为4组，每组20例：Ⅰ组罗库溴铵对照组，Ⅱ组罗库溴铵预注组，Ⅲ组麻黄碱预处理组，Ⅳ组预注法复合麻黄碱预处理组。入室后开放手背静脉，常规监测EKG、NIBP、SpO2，连接加速度肌松监测仪。在麻醉诱导前预先静注：Ⅰ组生理盐水0.5ml，Ⅱ组罗库溴铵0.06mg•kg-1，Ⅲ组麻黄碱70µg•kg-1，Ⅳ组罗库溴铵0.06mg•kg-1和麻黄碱70µg•kg-1。然后进行麻醉诱导，咪唑安定0.1mg•kg-1，氯胺酮1mg•kg-1，异丙酚2～2.5mg•kg-1。患儿入睡后进行肌松定标。麻醉诱导的第4min静注插管剂量的肌松药，Ⅰ组、Ⅲ组罗库溴铵0.6mg•kg-1，Ⅱ组、Ⅳ组罗库溴铵0.54mg•kg-1。
起效时间和插管条件 Ⅰ、Ⅱ、Ⅲ、Ⅳ组的最大阻滞起效时间分别为196±43、140±43、144±35、（100±33）s；Ⅱ组、Ⅲ组、Ⅳ组的起效时间明显快于Ⅰ组(P <0.01)；Ⅳ组的起效时间较Ⅱ组、Ⅲ组加快(P <0.01)（见表2）。各组病人气管插管条件按照Cooper法评分标准均达到8～10分，优良率100%，仅Ⅲ组有1例患儿在气管插管时出现了轻度呛咳，各组间的差别无统计学意义。 表2 罗库溴铵起效时间（s，n=20，x ±s）
1 Leykin Y, Pellis T, Lucca M, et al. Effects of ephedrine on intubating conditions following priming with rocuromium. Acta Anaesthesiol Scand, 2005, 49(6):792-797. 2 Cooper R, Mirakhur RK, Clarke RS, et al. Comparison of intubating conditions after administration of Org 9246 (rocuronium) and suxamethonium. Br J Anaesth, 1992, 69(3):269-273. 3 沈建军,徐丽丽. 罗库溴铵在小儿眼科手术中的应用. 内蒙古医学杂志, 2005, 37(6):522-523. 4 Eikermann M, Hunkemoller I, Peine L, et al. Optimal rocuronium dose for intubation during inhalation induction with sevoflurane in children. Br J Anaesth, 2002, 89(2):277-281. 5 林长赋,李冬梅,李文志,等. 预注罗库溴铵对小儿全麻诱导插管肌松效果的影响. 临床麻醉学杂志, 2002, 18(11):601-602. 6 Ezri T, Szmunk P, Warters RD, et al. Changes in onset time of rocuronium in patients pretreated with ephedrine and esmolol: the role of cardiac output. Acta Anaesthesiol Scand, 2003, 47(9):1067–1072. |
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