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目的观察2×95%的有效药物剂量(ED95)采用预注给药对儿童顺式阿曲库铵药效学及气管插管条件的影响。方法 39例2～10岁美国麻醉医师学会分级Ⅰ～Ⅱ级行择期手术的患儿被随机分为3组,每组13例:D组(2×ED95单次剂量组)单次静脉注射顺式阿曲库铵100μg/kg;Y组(2×ED95预注组)先静脉预注顺式阿曲库铵10μg/kg,5min后注入余量90μg/kg;S组(3×ED95单次剂量组)单次静脉注射顺式阿曲库铵150μg/kg。麻醉诱导用咪达唑仑0.1mg/kg、芬太尼2μg/kg、丙泊酚2～4mg/kg及相应剂量顺式阿曲库铵。采用肌肉松弛监测仪对尺神经进行连续4个成串刺激(TOF)监测。记录各组起效时间[肌肉松弛药注射完毕至第1个肌颤搐反应高度(T1)消失为最大抑制时间]、阻滞维持时间(肌肉松弛药注射完毕至T1恢复到5%的时间)、临床作用时间(肌肉松弛药注射完毕至T1恢复到25%的时间)、体内作用时间(肌肉松弛药注射完毕至T1恢复到95%的时间)及恢复指数(T1从25%恢复到75%的时间);观察预注间期(预注量注射完毕至注入余下剂量前的5min)TOF的变化。结果 3组间年龄、性别构成、体重及气管插管条件评估分级间的差异均无统计学意义(P值均>0.05),Y组预注间期TOF值为1,无变化。S组的起效时间显著短于D组和Y组(P值均<0.05),但D组与Y组间差异无统计学意义(P>0.05)。S组的阻滞维持时间、临床作用时间、体内作用时间均较D组和Y组显著延长(P值均<0.05),D组与Y组间差异无统计学意义(P值均>0.05)。3组间恢复指数的差异均无统计学意义(P值均>0.05)。结论 2×ED95剂量顺式阿曲库铵以10μg/kg为预注剂量、90μg/kg为余量应用于儿童麻醉诱导无明显优势。无论预注与否,2×ED95剂量的效果均不及3×ED95。
Objective To observe the effect of pretreatment on the pharmacodynamics and intubation conditions of cisatracurium in children with 2 × 95% effective drug dose (ED95). Methods Thirty-nine American College of Anesthesiologists aged from Ⅰ to Ⅱ were randomly divided into three groups (n = 13): Group D (2 × ED95 single-dose group), single intravenous injection Atracurium 100 μg / kg; Y group (2 × ED95 pre-injection group) pre-injection of cisatracurium 10 μg / kg, 5 minutes after the injection of 90 μg / kg; S group (3 × ED95 single Dose group) A single intravenous cisatracurium 150μg / kg. Induction of anesthesia with midazolam 0.1mg / kg, fentanyl 2μg / kg, propofol 2 ~ 4mg / kg and the corresponding dose of cisatracurium. Four consecutive stimuli (TOF) were performed on the ulnar nerve using a muscle relaxation monitor. The onset time of each group was recorded [maximal inhibition time from the completion of muscle relaxant injection until the first twitch response height (T1) disappeared], and the blockage maintenance time (5 to 6 days after the completion of muscle relaxant injection) , Clinical duration of action (recovery of muscle relaxant to 25% of T1 after injection), duration of in vivo action (recovery of muscle relaxant to 95% of T1 after T1) and recovery index (T1 from 25% to 75% Of the time); observed pre-injection interval (pre-injection of injected until the remaining dose of 5min) TOF changes. Results There was no significant difference in age, sex composition, body weight and grade of endotracheal intubation assessment between the three groups (P> 0.05). There was no change in TOF value of group Y during the pre-injection period. The onset time of S group was significantly shorter than that of D group and Y group (all P <0.05), but there was no significant difference between D group and Y group (P> 0.05). The duration of blockade, clinical duration and duration of action in group S were significantly longer than those in group D and group Y (all P <0.05). There was no significant difference between group D and group Y (P> 0.05) . There was no significant difference in recovery index between the three groups (P> 0.05). Conclusion 2 × ED95 dose of atracurium in 10μg / kg as the pre-dose, 90μg / kg as the margin for the induction of anesthesia in children without obvious advantages. Regardless of pre-injection or not, the 2 × ED95 doses were less effective than 3 × ED95.