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| 闭环靶控输注罗库溴铵在患儿麻醉中的应用 |
| Application of closed-loop target-controlled infusion of rocuronium in pediatric anesthesia |
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| DOI：10.12089/jca.2019.11.009 |
| 中文关键词: 闭环靶控输注 罗库溴铵 患儿 恢复指数 |
| 英文关键词: Closed-loop target-controlled infusion Rocuronium Pediatric Recovery index |
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| 中文摘要: |
目的 比较闭环靶控与传统持续两种不同药物输注方法,输注罗库溴铵在患儿麻醉中的效果。
方法 择期行下腹部手术的患儿86例,男53例,女33例,年龄1～3岁,BMI 14～21 kg/m2,ASA Ⅰ或Ⅱ级。用随机数字表法分为闭环组(C组)和持续组(S组),每组43例。诱导时两组均给予罗库溴铵0.6 mg/kg,当四个成串刺激中第一次肌颤搐(T1)到达最大阻滞时气管插管。麻醉维持C组使用T1闭环肌松模式,设置T1=20％为增药条件,增药速度30 μg·kg-1·min-1,维持速度1.60 μg·kg-1·min-1,自动调整罗库溴铵用量。S组恒速泵注罗库溴铵5 μg·kg-1·min-1,肌松不满意时单次追加罗库溴铵0.2 mg/kg。记录术中丙泊酚总用量、瑞芬太尼总用量和罗库溴铵总用量,罗库溴铵追加次数。记录两组肌松恢复指数(RI)、罗库溴铵停药至术毕时间、手术时间、麻醉时间、拔管时间和PACU停留时间。记录术后呼吸抑制、低氧血症等麻醉并发症发生情况。结果C组RI明显低于S组(P < 0.05)、罗库溴铵追加次数明显低于S组(P < 0.05),拔管时间明显短于S组(P < 0.05)。两组丙泊酚总用量、瑞芬太尼总用量、罗库溴铵总用量、罗库溴铵停药至术毕时间、手术时间、麻醉时间和PACU停留时间差异无统计学意义。两组均未见术后呼吸抑制,低氧血症等麻醉相关并发症。
结论 与持续输注法比较,闭环靶控输注罗库溴铵用于1～3岁患儿下腹部手术的恢复指数明显降低,肌松恢复更快速,术中患儿肌松效果更加确切,稳定。 |
| 英文摘要: |
Ojective To compare the effects of rocuronium bromide between closed loop controlled infusion and traditional continuous infusion in pediatric anesthesia.
Methods Eighty-six paediatric patients underwent lower abdominal surgery, including 53 males and 33 females, aged 1-3 years, BMI 14-21 kg/m2, ASA physical status Ⅰ or Ⅱ, were divided into closed loop controlled infusion group (group C) and traditional continuous infusion group (group S) by random number table method, 43 patients in each group. Rocuronium bromide at a dose of 0.6 mg/kg was administrated in both groups during anesthesia induction and endotracheal intubation was conducted when the first twitch (T1) of train-of-four stimulation reached maximum blockade effect. During maintenance of anesthesia, T1 closed loop muscle relaxation mode was applied in group C with T1 = 20％ as a criterion of increasing dosage at a rate of 30 μg·kg-1·min-1. Maintainance rate was 1.60 μg·kg-1·min-1 and the dosage of rocuronium bromide was adjusted automaticly. While in group S, rocuronium bromide was infused in a constant rate of 5 μg·kg-1·min-1. A single dose of 0.2 mg/kg rocuronium bromide was added when muscle relaxation was unsatisfactory. Dosage of propofol, remifentaniland rocuronium, and the additional times of rocuronium were recorded. Muscle relaxation recovery index (RI), the time from rocuronium bromide withdrawl to the end of operation, duration of anesthesia and operation, duration of stay in PACU and extubation time were recorded. The occurrence of anesthesia complications such as postoperative respiratory depression and hypoxemia was recorded.
Results RI in group C was significantly lower than that in group S (P < 0.05). The additional times of rocuronium during operation in group C was significantly less than that in group S (P < 0.05). Extubation time in group C was significantly shorter than that in group S (P < 0.05). There was no statistic difference in dosage of propofol, remifentanil, and rocuronium, interval from rocuronium bromide withdrawl to the end of operation, duration of stay in PACU, duration of anesthesia and operation between the two groups. Anaesthesia-related complications were not observed in both groups.
Conclusion Compared with continuous infusion, infusing rocuronium bromide by closed loop controlled mode shows lower RI, faster muscle relaxation recovery in paediatric patients aged 1-3 years in lower abdominal surgery, with more exact and stable muscle relaxation effect during operation. |
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