闭环靶控输注顺式阿曲库铵在腹腔镜手术患儿中的应用

Application of closed-loop target controlled infusion of cisatracurium in pediatric laparoscopic anesthesia

中文关键词: 闭环靶控输注  顺式阿曲库铵  儿童  腹腔镜

英文关键词: Closed-loop target-controlled infusion  Cisatracurium  Child  Laparoscopic

中文摘要:

      
目的 比较闭环靶控和间断给药两种方法输注顺式阿曲库铵在腹腔镜手术患儿中的效果。
方法 选择择期行腹腔镜手术患儿72例，男45例，女27例，年龄2～8岁，BMI 14～21 kg/m²，ASA Ⅰ或Ⅱ级。采用随机数表法将患儿分为闭环组（C组）和间断组（I组），每组36例。麻醉诱导时两组均给予顺式阿曲库铵0.15 mg/kg。当四个成串刺激（TOF）第一次肌颤搐（T1）到达最大阻滞时进行气管插管。麻醉维持时C组使用T1闭环模式，设置T1=20%为增药的条件，调整顺式阿曲库铵用量，增药量5 μg·kg^-1·min^-1，维持量0.2 μg·kg^-1·min^-1。I组在T1≥20%时静注顺式阿曲库铵0.03 mg/kg。记录术中顺式阿曲库铵总用量及追加次数、肌松恢复指数（RI）、T1恢复至75%（T1=75%）和90%（T1=90%）的时间、T4与T1的比值（TOFr）恢复至0.75（TOFr=0.75）和0.90（TOFr=0.90）的时间、手术时间和拔管时间。记录术后并发症发生情况。
结果 两组顺式阿曲库铵总用量、术中追加次数以及TOFr=0.75和TOFr=0.90的时间差异无统计学意义。C组拔管时间、RI、T1=75%和T1=90%的时间明显短于I组（P＜0.05）。两组均未出现术后肌松残余或低氧血症等并发症。
结论 与相比于传统间断给药比较，闭环靶控输注顺式阿曲库铵应用于腹腔镜手术患儿的肌松恢复更快。

英文摘要:

      
Objective To compare the effect of cisatracurium infusion via closed-loop target-controlled or intermittent infusion in pediatric anesthesia during laparoscopic surgery.
Methods seventy-nine children undergoing laparoscopic surgery, 45 males and 27 females, aged 2-8 years, BMI 14-21 kg/m²,ASA physical status Ⅰ or Ⅱ, were divided into closed-loop group (group C) and intermittent group (group I) by random number table method, 36 children in each group. Cisatracurium 0.15 mg/kg was given to both groups during anesthesia induction. Endotracheal intubation was conducted when the first twitch (T1) of train-of-four stimulation reached the maximum blockade effect. During maintenance of anesthesia, group C used T1 closed-loop muscle relaxation mode, T1 = 20% was set as a criterion of increasing dosage at a rate of 5 μg·kg^-1·min^-1, maintained at 0.2 μg·kg^-1·min^-1. In group I, cisatracurium 0.03 mg/kg was given once when T1 ≥ 20% or muscle relaxation was not satisfied. The total dosage of cisatracurium and the time of cisatracurium addition, recovery indiex (RI), the time of T1 recovered to 75% (T1 = 75%) and 90% (T1 = 90%), the time of TOFr recovered to 0.75 (TOFr = 0.75) and 0.90 (TOFr = 0.90) were recorded. The time from the withdrawal of cisatracurium to the end of operation, operation time, anesthesia time and extubation time were recorded. The occurrence of postoperative anesthesia complications was recorded.
Results Compared with group I, the extubation time, RI, the time of T1 = 75% and T1 = 90% was significantly shorter in group C (P < 0.05). There were no significant differences in the total dosage of cistracurium atracurium, the additional times of cisatracurium atracurium between the two groups. There were no anesthesia complications such as residual muscle relaxation or hypoxemia in both groups.
Conclusion Compared with the traditional intermittent infusion method, the closed-loop target-controlled infusion of cisatracurium shows faster muscle relaxation recovery laparoscopic in surgery for children.