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目的探讨先天性心脏病婴幼儿低温心肺转流(CPB)对罗库溴铵肌松药作用的影响。方法先天性心脏病患儿30例,年龄4个月-3岁,低温CPB下实施心内手术。全麻诱导后静注罗库溴铵0.6mg/kg,采用四次成串刺激(TOF)模式评估神经-肌肉阻滞。T1最大抑制时实施气管插管;术中T1=25%时静注罗库溴铵0.2mg/kg。记录CPB前、中、后三阶段静注罗库溴铵0.2mg/kg的起效时间、无反应时间和T1恢复至10%、25%和75%的时间,计算肌松恢复指数。结果低温CPB中,罗库溴铵的以上肌松监测指标均较CPB前延长(P<0.01);低温CPB后的以上指标仍较CPB前延长(P<0.05)。结论婴幼儿低温CPB期间,罗库溴铵的起效及作用时间延长、恢复延迟,且在CPB后仍不能恢复至CPB前的水平。建议对于婴幼儿心脏手术,低温CPB中、后均应适当减少肌松药的用量。
Objective To investigate the effect of low temperature cardiopulmonary bypass (CPB) on rocuronium in patients with congenital heart disease. Methods Thirty children with congenital heart disease aged 4 months to 3 years underwent cardiac surgery under hypothermia CPB. After induction of general anesthesia, rocuronium 0.6 mg / kg was administered intravenously, and neuro-muscular retardation was assessed by four-time series of stimulation (TOF) patterns. T1 maximum inhibition of tracheal intubation; intraoperative injection of rocuronium 0.2mg / kg at T1 = 25%. The onset time of rocuronium 0.2mg / kg was recorded before, during and after CPB, and the recovery time of muscle relaxant was calculated after no reaction time and T1 recovery to 10%, 25% and 75% respectively. Results In low-temperature CPB, the above indicators of rocuronium were longer than those before CPB (P <0.01). The above indexes were still longer than those before CPB (P <0.05). Conclusion The onset and duration of action of rocuronium in infants and young children during CPB are delayed and the recovery is delayed. CPR still can not recover to the level before CPB. Recommendations for infants and young children cardiac surgery, hypothermia in CPB, should be appropriate to reduce the amount of muscle relaxants.