婴幼儿肌注罗库溴铵的肌松作用和插管条件

目的观察先心病婴幼儿肌注罗库溴铵的肌松效果、插管条件和安全性。方法30例先心病择期全麻手术患儿,随机分为3组,每组10例,组Ⅰ、Ⅱ分别肌注罗库溴铵1、2mg/kg,组Ⅲ肌注琥珀胆碱4mg/kg,肌注部位均为上肢三角肌。采用TOF-Watch加速度仪刺激尺神经和测定拇内收肌收缩功能。结果各组肌颤搐Th抑制>75%在6min者分别为4、9、0例,组Ⅲ与组Ⅱ比较有显著差异(P<0.01),Th抑制达到75%以上者插管条件均为优良。Th抑制75%的起效时间,组Ⅲ与组Ⅰ、Ⅱ比较均有显著差异(P<0.05);Th恢复至25%,各组两两比较均有显著差异(P<0.01)。结论婴幼儿肌注罗库溴铵2mg/kg能在4~6min内提供优良的插管条件,但临床肌松作用长达2h以上。肌注琥珀胆碱不能提供有效的肌松作用和插管条件。

Neuromuscular Blockade and Intubation Conditions Following Intramuscular Rocuronium in Infants

ObjectiveTo observe the muscle relaxation,intubation conditions and safety of intramuscular rocuronium in infants with congenital heart disease.MethodsThirty infants scheduled for elective surgical procedures were randomly allocated to injected intramuscular rocuronium (1 or 2 mg/kg) or succinylcholine (4 mg/kg) into deltoid muscle,respectively. The adductor pollicis twitch were measured by accelerometry. Intubation condition were (assessed) at twitch depression to >75%.ResultsThe number of patients achieved >75% twitch depression after (6 min) of drugs administration were 4,9,and 0 (P<0.01). Intubation conditions were consistently good-excellent when twitch depression achieved >75% in all groups. Times of 25% twitch recovery were significantly different after drugs administration (P<0.01).(Conclusion)Intramuscular rocuronium,2 mg/kg,can provide good-excellent (intubation) condition within 4 to 6 min and long duration of action about 2 h. Duration of action of large dose rocuronium might limit clinical utility. Intramuscular succinylcholine does not provide satisfactory tracheal intubating condition in infants with congenital heart disease.