【摘要】：【目的】觀察羅庫(kù)溴銨與琥珀膽堿在小兒氣道異物取出術(shù)中維持肌松的臨床效果、術(shù)中術(shù)后并發(fā)癥的發(fā)生及術(shù)后拔管、肌力恢復(fù)情況�！痉椒ā窟x擇我院2013年1月至2016年1月80例擇期行氣道異物取出術(shù)患兒,其中30例為年齡大于3歲患兒,根據(jù)麻醉誘導(dǎo)時(shí)靜注的肌松藥隨機(jī)分為2組(n=40):羅庫(kù)溴銨組(R組)0.9 mg/kg,琥珀膽堿組(S組)1.5 mg/kg;術(shù)中根據(jù)肌松程度及手術(shù)時(shí)間,R組必要時(shí)追加靜注羅庫(kù)溴銨0.3 mg/kg,S組必要時(shí)追加靜注琥珀膽堿0.5 mg/kg,其余用藥一致。觀察項(xiàng)目包括:支氣管鏡置入條件比較,術(shù)中肌松程度,追加靜注肌松藥和阿托品的次數(shù),氣管插管拔除時(shí)間,術(shù)中術(shù)后生命征、血流動(dòng)力學(xué)動(dòng)態(tài)觀察及并發(fā)癥的發(fā)生情況,年齡大于3歲患兒術(shù)后24 h肌肉酸痛發(fā)生率�！窘Y(jié)果】(1)兩組患兒支氣管鏡置入條件比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(2)兩組術(shù)中肌松程度無(wú)明顯差別,但R組患兒均無(wú)需追加肌松藥及阿托品,而S組所有患兒均需追加肌松藥和阿托品,兩組間比較差異有統(tǒng)計(jì)學(xué)意義(P0.01)。(3)術(shù)中術(shù)后生命征、血流動(dòng)力學(xué)動(dòng)態(tài)觀察平穩(wěn),兩組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);S組患兒有出現(xiàn)體動(dòng)、低氧血癥、蘇醒期躁動(dòng)等并發(fā)癥,而R組僅出現(xiàn)喉痙攣及蘇醒期躁動(dòng)各1例,兩組間比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(4)術(shù)后15 min S組患兒肌力恢復(fù)比R組明顯,肌力恢復(fù)程度與R組比較差異有統(tǒng)計(jì)學(xué)意義(P0.01)。(5)手術(shù)結(jié)束后氣管插管拔除時(shí)間R組患兒比S組延長(zhǎng),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(6)術(shù)后24 h隨訪30例年齡大于3歲患兒,S組(14例)患兒表現(xiàn)為軀干及四肢肌肉酸痛;R組(16例)患兒均無(wú)全身肌肉酸痛發(fā)生,兩組比較差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。【結(jié)論】小兒氣道異物取出術(shù)中應(yīng)用羅庫(kù)溴銨與琥珀膽堿均有較好肌松效果,前者肌松效果更佳,安全性更好,可提供更好的手術(shù)條件和持續(xù)平衡的麻醉深度,術(shù)后24 h無(wú)肌肉酸痛,后者術(shù)中大多須繼續(xù)追加藥物,且術(shù)中、術(shù)后易出現(xiàn)并發(fā)癥,術(shù)后24 h出現(xiàn)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.
【作者單位】： 福建醫(yī)科大學(xué)附屬第二醫(yī)院耳鼻咽喉頭頸外科;福建醫(yī)科大學(xué)附屬第二醫(yī)院麻醉科;
【分類(lèi)號(hào)】：R726.1

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本文編號(hào)：2161999