两种肌松药在小儿气道异物取出术中的疗效分析

发布时间：2018-08-03 14:14

【摘要】：【目的】观察罗库溴铵与琥珀胆碱在小儿气道异物取出术中维持肌松的临床效果、术中术后并发症的发生及术后拔管、肌力恢复情况。【方法】选择我院2013年1月至2016年1月80例择期行气道异物取出术患儿,其中30例为年龄大于3岁患儿,根据麻醉诱导时静注的肌松药随机分为2组(n=40):罗库溴铵组(R组)0.9 mg/kg,琥珀胆碱组(S组)1.5 mg/kg;术中根据肌松程度及手术时间,R组必要时追加静注罗库溴铵0.3 mg/kg,S组必要时追加静注琥珀胆碱0.5 mg/kg,其余用药一致。观察项目包括:支气管镜置入条件比较,术中肌松程度,追加静注肌松药和阿托品的次数,气管插管拔除时间,术中术后生命征、血流动力学动态观察及并发症的发生情况,年龄大于3岁患儿术后24 h肌肉酸痛发生率。【结果】(1)两组患儿支气管镜置入条件比较差异无统计学意义(P0.05)。(2)两组术中肌松程度无明显差别,但R组患儿均无需追加肌松药及阿托品,而S组所有患儿均需追加肌松药和阿托品,两组间比较差异有统计学意义(P0.01)。(3)术中术后生命征、血流动力学动态观察平稳,两组间比较差异无统计学意义(P0.05);S组患儿有出现体动、低氧血症、苏醒期躁动等并发症,而R组仅出现喉痉挛及苏醒期躁动各1例,两组间比较差异有统计学意义(P0.05)。(4)术后15 min S组患儿肌力恢复比R组明显,肌力恢复程度与R组比较差异有统计学意义(P0.01)。(5)手术结束后气管插管拔除时间R组患儿比S组延长,差异有统计学意义(P0.05)。(6)术后24 h随访30例年龄大于3岁患儿,S组(14例)患儿表现为躯干及四肢肌肉酸痛;R组(16例)患儿均无全身肌肉酸痛发生,两组比较差异有显著统计学意义(P0.01)。【结论】小儿气道异物取出术中应用罗库溴铵与琥珀胆碱均有较好肌松效果,前者肌松效果更佳,安全性更好,可提供更好的手术条件和持续平衡的麻醉深度,术后24 h无肌肉酸痛,后者术中大多须继续追加药物,且术中、术后易出现并发症,术后24 h出现肌肉酸痛。
[Abstract]:[objective] to observe the clinical effect of rocuronium bromide and succinylcholine on the maintenance of muscle relaxation during the removal of foreign bodies in children's airway, the occurrence of complications during and after operation and the extubation after operation. [methods] from January 2013 to January 2016, 80 children with airway foreign body removal were selected, 30 of whom were over 3 years old. According to the intravenously injected muscle relaxants during anesthesia induction, they were randomly divided into two groups: rocuronium group (R group) 0.9 mg / kg, succinylcholine group (S group) 1.5 mg / kg, and intraoperative intravenous injection of rocuronium 0.3 mg / kg S group when necessary according to the degree of muscle relaxation and the time of operation. Succinylcholine was injected intravenously at 0.5 mg / kg, and the rest were consistent. The observation items included: bronchoscopic implantation conditions comparison, intraoperative muscle relaxation degree, times of additional intravenous injection of muscle relaxant and atropine, extraction time of tracheal intubation, life sign during and after operation, dynamic observation of hemodynamics and occurrence of complications. [results] [results] (1) there was no significant difference in the degree of muscle relaxation between the two groups (P0.05). (2). But there was no need to add muscle relaxant and atropine in group R, and all children in group S needed muscle relaxant and atropine. The difference between the two groups was statistically significant (P0.01). (3), the dynamic observation of hemodynamics was stable, the difference was statistically significant (P0.01). (3). There was no significant difference between the two groups (P0.05) there were complications such as body movement, hypoxemia, restlessness in recovery period in group S, while in group R, laryngeal spasm and restlessness occurred in one case each. There was significant difference between the two groups (P0.05). (4). The recovery of muscle strength in group S was significantly higher than that in group R 15 min after operation (P0.01). (5). The time of tracheal intubation extubation in group R was longer than that in group S (P0.01). (5). The difference was statistically significant (P0.05). (6). 30 children aged more than 3 years were followed up 24 hours after operation. In group S (14 cases), there was no systemic muscle soreness in group R (16 cases). [conclusion] both rocuronium and succinylcholine had better muscle relaxation effect during the removal of airway foreign body in children (P0.01). The former had better muscle relaxation effect and better safety. It can provide better operation conditions and balanced anesthesia depth. There is no muscle soreness 24 hours after operation. Most of the latter need to continue to add drugs during the operation, and complications may occur during the operation and muscle soreness 24 hours after the operation.
【作者单位】：福建医科大学附属第二医院耳鼻咽喉头颈外科;福建医科大学附属第二医院麻醉科;
【分类号】：R726.1

【参考文献】