不同剂量顺式阿曲库铵对小儿肌松的作用比较.docVIP

不同剂量顺式阿曲库铵对小儿肌松的作用比较 　　[摘 要] 目的：比较不同剂量顺式阿曲库铵在小儿外科手术中的肌松作用，探讨其临床使用中最适剂量。方法： 48位患儿随机分为3组，分别应用2倍ED95，3倍ED95和4倍ED95的顺式阿曲库铵进行随机对照研究，观察3组患儿肌松药起效时间、有效作用时间、插管条件、血流动力学等指标。结果：3组间注射顺式阿曲库铵前及注射1～5min后心率、平均动脉压差异无统计学意义。高剂量组（3倍ED95和4倍ED95）顺式阿曲库铵起效时间、有效作用时间、体内作用时间均短于和久于2倍ED95剂量组，差异有统计学意义。3组间恢复指数差异无统计学意义。高剂量组能获得较好的插管条件，与低剂量组比较差异具有统计学意义。但3倍ED95和4倍ED95剂量组在起效时间、插管条件等方面差异无统计学意义。结论：小儿应用3倍ED95和4倍ED95顺式阿曲库铵有着更快速的神经肌松作用，且持续时间更长、血流动力学更稳定。3倍ED95为最合适的诱导剂量。 　　[关键词] 顺式阿曲库铵；剂量；神经肌肉阻滞；小儿 　　中图分类号：R614.2 文献标识码：A 文章编号：2095-5200（2014）03-011-03 　　[Abstract] Objective： To investigate the most proper dose of cisatracurium by comparing the neuromuscular blockade of children under cisatracurium anesthesia. Method： The study was designed as a randomized controlled clinical trial including 48 children divided into 3 groups. The onset time， effective duration， intubating condition and hemodynamic change were observed. Result： There is no statistically significant difference between heart rate and mean average blood pressure of children of 3 groups before or 1-5 minutes after the injection of cisatracurium. Higher doses of cisatracurium （3×ED95 and 4×ED95） showed onset time and effective duration were statistically significant lower and longer than lower dose of cisatracurium （2×ED95） respectively. At the same time， higher dose of cisatracurium had a better intubating condition than lower dose of cisatracurium， statistically. But no statistically significant difference was observed on onset time， intubating condition and so on between 3×ED95 and 4×ED95 dose of cisatracurium. Conclusion： The usage of 3×ED95 and 4×ED95 dose of cisatracurium provide a more effective and rapidly neuromuscular blockade in children with longer duration and hemodynamic hemostasis. 3×ED95 dose of cisatracurium is recommended as the initial dose. 　　[Key words] cisatracurium；doses；neuromuscular blockade；children 　　由于小儿各项生理功能未健全，所以小儿手术麻醉对肌松药物选择有较高要求。一些生理因素如神经肌肉接头发育、肌肉纤维分布的不同及细胞外液容量的不同均影响非去极化肌松药起效及恢复的时间。所以，选择更适合小儿特点的肌松药物，选择使用更适宜的剂量，