摘要:
目的 观察不同剂量米库氯铵对不同年龄患儿肌松时效和血流动力学的影响.方法 选取2016年1月至2017年1月行气管内插管全身麻醉的择期腹股沟疝修补术患儿100例,年龄0.5~6.0岁.根据年龄将患儿分为低龄组(0.5~3.0岁)和高龄组(3.1~6.0岁);再依据米库氯铵使用剂量将每组患儿分为低剂量组和高剂量组,米库氯铵诱导剂量分别为0.20和0.25 mg/kg,即低龄低剂量组、低龄高剂量组、高龄低剂量组和高龄高剂量组,每组25例.记录麻醉诱导前(T0)及给予诱导剂量米库氯铵后1 min(T1)、3 min(T2)、5 min(T3)、10 min(T4)的平均动脉压(MAP)和心率;肌松起效时间,即首次静脉注射米库氯铵即刻至肌颤搐阻滞75%(ThD75)、90% (ThD90)、最大阻滞(ThDmax)所需的时间;恢复指数(RI);肌松恢复时间,即末次静脉注射米库氯铵至肌颤搐出现即刻(Th)、恢复10%(ThR10)、恢复25%(ThR25)、恢复75%(ThR75)、恢复90%(ThR90)的时间,第4个肌颤搐与第1个肌颤搐比值(TOFR)恢复至75%(TOFR75)和90%(TOFR90)的时间.结果 四组各时间点MAP和心率比较差异均无统计学意义(P>0.05).低龄低剂量组ThD75、ThD90和ThDmax分别为(126 ± 40)、(163 ± 59)和(192 ± 49)s,低龄高剂量组分别为(73 ± 15)、(115 ± 41)和(142 ± 37)s,高龄低剂量组分别为(149 ± 38)、(193 ± 44)和(221 ± 47)s,高龄高剂量组分别为(105 ± 32)、(138 ± 35)和(167 ± 44)s.低龄高剂量组ThD75、ThD90和ThDmax均明显短于低龄低剂量组,高龄高剂量组均明显短于高龄低剂量组,高龄低剂量组均明显长于低龄低剂量组,高龄高剂量组均明显长于低龄高剂量组,差异均有统计学意义(P<0.05).低龄低剂量组与低龄高剂量组、高龄低剂量组与高龄高剂量组Th、ThR10、ThR25、ThD75、ThD90、RI、TOFR75和TOFR90比较差异均无统计学意义(P>0.05).结论 米库氯铵在0.5~3.0岁患儿中起效显著快于3.1~6.0岁患儿.与0.20 mg/kg米库氯铵相比,0.25 mg/kg米库氯铵肌松起效时间更短.米库氯铵肌松恢复时间不受年龄及诱导剂量影响且对血流动力学无明显影响.%Objective To observe the effect of different doses of mivacurium chloride on muscle relaxation time-course and hemodynamics in children with different ages. Methods One hundred children of selective inguinal hernia repair under general anesthesia with endotracheal intubation from January 2016 to January 2017 were enrolled, and the age was 0.5 to 6.0 years. The children were divided into low age group (0.5 to 3.0 years) and high age group (3.1 to 6.0 years) according to the age, then the children were divided into low dose group (mivacurium chloride 0.20 mg/kg) and high dose group (mivacurium chloride 0.25 mg/kg) according to the doses of mivacurium chloride. Therefore, the children were divided into low age low dose group, low age high dose group, high age low dose group and high age high dose group with 25 cases each. The mean arterial pressure (MAP) and heart rates before anesthesia (T0) and 1 min (T1), 3 min (T2), 5 min (T3), 10 min (T4) after intravenous injection of mivacurium chloride were recorded. The times of first intravenous injection of mivacurium chloride to neuromuscular block 75% (ThD75), 90% (ThD90) and maximum (ThDmax) were recorded. The recovery index (RI) was recorded. The times of last intravenous injection of mivacurium chloride to onset of muscle convulsions (Th) and muscle convulsions recovery 10% (ThR10), 25% (ThR25), 75% (ThR75), 90% (ThR90) were recorded. The times of ratio of the fourth muscle twitch to the first muscle twitch (TOFR) recovery 75% (TOFR75) and 90% (TOFR90) were recorded. Results There were no statistical difference in MAP and heart rate among 4 groups (P>0.05). The ThD75, ThD90 and ThDmax in low age low dose group were (126 ± 40), (163 ± 59) and (192 ± 49) s, those in low age high dose group were (73 ± 15), (115 ± 41) and (142 ± 37) s, those in high age low dose group were (149 ± 38), (193 ± 44) and (221 ± 47)s, and those in high age high dose group were (105 ± 32), (138 ± 35) and (167 ± 44)s. The ThD75, ThD90 and ThDmax in low age high dose group were significantly shorter than those in low age low dose group, those in high age high dose group were significantly shorter than those in high age low dose group, those in high age low dose group were significantly longer than those in low age low dose group, those in high age high dose group were significantly longer than those in low age high dose group, and there were statistical differences (P<0.05). There were no statistical differences in Th, ThR10, ThR25, ThD75, ThD90, RI, TOFR75 and TOFR90 among low age low dose group and low age high dose group, high age low dose group and high age high dose group (P>0.05). Conclusions In the children of 0.5 to 3.0 years, the effect of mivacurium chloride is significantly faster than that in the children of aged 3.1 to 6.0 years. Compared with 0.20 mg/kg of mivacurium chloride, 0.25 mg/kg of mivacurium chloride has less time to display muscle relaxation effect. The recovery time is not affected by age and induction dose. Mivacurium chloride has no significant effect on hemodynamics.