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目的观察吸入1.3倍最低有效肺泡浓度(MAC)七氟烷和地氟烷对患儿手术中罗库溴铵持续输注速率的影响。方法全身麻醉下择期进行手术的患儿60例随机均分为试验组Ⅰ(地氟烷组)、试验组Ⅱ(七氟烷组)和对照组(丙泊酚组),每组20例。3组开始均用靶控输注丙泊酚(血浆浓度3~4μg·mL~(-1))诱导和维持麻醉,静脉滴注0.6 mg·kg~(-1)罗库溴铵气管插管。用肌松监测仪对腕部尺神经进行4个成串刺激(TOF),拇指内收肌依次出现4个肌颤搐分别记录为T_1、T_2、T_3和T_4。T_1恢复至5%开始输注罗库溴铵,调节输注速率始终维持T_1值在8%~10%,T_1稳定5 min时(t_0)的输注速度为初始输注速率,随即试验组Ⅰ和试验组Ⅱ停止输注丙泊酚,分别吸入七氟烷和地氟烷,并使呼气末浓度稳定于1.3 MAC,对照组继续输注丙泊酚。3组患儿每10 min记录一次罗库溴铵输注速率变化,各时点分别以t_1、t_2、t_3、t_4……表示(以此类推);停止肌肉松弛药后,记录Tl恢复至25%所需时间、Tl从25%恢复至75%所需时间(恢复指数)及四个成串刺激比(TOFr)恢复至90%所需时间。结果试验组Ⅰ、试验组Ⅱ和对照组患儿t_0时的罗库溴铵输注速率分别为(9.02±1.94),(9.25±2.01),(9.08±1.96)μg·kg~(-1)·min~(-1);试验组Ⅰ和试验组Ⅱ输注速率随吸入麻醉时间延长而显著下降(P<0.05),t7时试验组Ⅰ和试验组Ⅱ罗库溴铵输注速率分别为(4.49±0.98),(4.63±1.12)μg·kg~(-1)·min~(-1),而对照组则始终未见明显下降(P>0.05);试验组Ⅰ和试验组Ⅱt_1~t7输注速率均显著低于对照组(P<0.05);t_1~t_5试验组Ⅰ的输注速率均低于试验组Ⅱ(P<0.05)。试验组Ⅰ、试验组Ⅱ和对照组停药后T_1恢复至25%时间分别为(16.65±10.96),(24.30±2.35),(18.25±11.31)min;T_1从25%恢复至75%时间分别为(7.40±2.54),(14.11±3.07),(8.55±4.60)min;TOFr恢复至90%的时间分别为(39.58±4.07),(53.05±4.12),(40.72±5.85)min;与对照组比较,试验组Ⅰ肌肉松弛恢复时间差异无统计学意义(P>0.05);试验组Ⅰ与试验组Ⅱ相比,肌肉松弛恢复时间差异有统计学意义(P<0.05)。3组均未出现严重药物不良反应,且药物不良反应发生率差异无统计学意义(P>0.05)。结论吸入1.3MAC七氟烷和地氟烷均能显著降低患儿罗库溴铵持续输注速率,一定时间内,地氟烷的疗效优于七氟烷,且不影响罗库溴铵的肌肉松弛恢复时间。
Objective To investigate the effects of inhaled 1.3-fold minimum effective alveolar concentration (MAC) sevoflurane and desflurane on the sustained infusion rate of rocuronium in children. Methods Sixty children with elective surgery under general anesthesia were randomly divided into experimental group Ⅰ (desflurane group), experimental group Ⅱ (sevoflurane group) and control group (propofol group), with 20 in each group. In the 3 groups, propofol (plasma concentration 3 ~ 4μg · mL -1) was used to induce and maintain the anesthesia. The patients were treated with 0.6 mg · kg -1 rocuronium tracheal intubation . The muscles of the ulnar nerve were subjected to four train-of-strand stimulation (TOF) with the muscle relaxation monitor, and the four muscle twitches of the thumb adduction were recorded as T_1, T_2, T_3 and T_4, respectively. T_1 returned to 5% started rocuronium infusion, the infusion rate was adjusted to maintain the T_1 value of 8% to 10%, T_1 stable 5min (t_0) infusion rate initial infusion rate, then test group Ⅰ And experimental group Ⅱ, propofol was stopped and sevoflurane and desflurane were inhaled respectively, and the end-expiratory concentration was stabilized at 1.3 MAC. Propofol was continued in the control group. The changes of rocuronium infusion rate in each group were recorded every 10 minutes. The time points were respectively expressed as t_1, t_2, t_3, t_4 ...... (and so on); after stopping the muscle relaxant, the recording Tl returned to 25 % Of the time required, the time it takes Tl to recover from 25% to 75% (recovery index), and the time it takes for four TOFs to recover to 90%. Results The rates of rocuronium infusion in experimental group Ⅰ, experimental group Ⅱ and control group were (9.02 ± 1.94), (9.25 ± 2.01), (9.08 ± 1.96) μg · kg -1 · Min ~ (-1). The infusion rate of test group Ⅰ and test group Ⅱ decreased significantly with the prolongation of inhalation anesthesia time (P <0.05). At t7, the infusion rates of rocuronium in test group Ⅰ and test group Ⅱ were (4.49 ± 0.98) and (4.63 ± 1.12) μg · kg -1 · min -1 in the control group, but no significant decrease in the control group (P> 0.05) (P <0.05). The infusion rate of t_1 ~ t_5 test group Ⅰ was lower than that of test group Ⅱ (P <0.05). The time of recovery from T_1 to 25% in experimental group Ⅰ, experimental group Ⅱ and control group were (16.65 ± 10.96), (24.30 ± 2.35) and (18.25 ± 11.31) min, respectively; the recovery of T_1 from 25% to 75% Were (7.40 ± 2.54), (14.11 ± 3.07) and (8.55 ± 4.60) min, respectively. The time of TOFr recovery to 90% was (39.58 ± 4.07), (53.05 ± 4.12) and (40.72 ± 5.85) min, There was no significant difference between the two groups (P> 0.05). There was significant difference between the two groups (P> 0.05). There was no serious adverse drug reaction in the three groups, and there was no significant difference in the incidence of adverse drug reactions (P> 0.05). CONCLUSION: 1.3MAC sevoflurane and desflurane can significantly reduce the sustained infusion rate of rocuronium in children, and the effect of desflurane is better than that of sevoflurane in a certain period of time, and does not affect the muscle of rocuronium Relaxation recovery time.