婴幼儿活体肝移植术中静脉注射顺阿曲库铵的药效学研究
R614.2; 目的·观察婴幼儿活体肝移植术中静脉注射顺阿曲库铵的药效学变化.方法·选择终末肝病期需择期行活体肝移植术的婴幼儿16例,年龄6～24个月,美国麻醉师协会(American Society of Anesthesiologists,ASA)分级为Ⅱ级或Ⅳ级.采用TOF-Watch肌松监测仪对尺神经进行连续4个成串刺激(train-of-four,TOF),观察拇内收肌的加速度变化.静脉注射0.15 mg/kg顺阿曲库铵诱导,T1为最大抑制程度时,行气管插管.T1恢复至3％时,输注起始剂量为2μg/(kg·min)的顺阿曲库铵,调节速率,维持90％～95％肌松抑制程度.分别记录注射首...
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| Published in | 上海交通大学学报（医学版） Vol. 41; no. 6; pp. 761 - 763 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Chinese |
| Published |
上海交通大学医学院附属仁济医院麻醉科,上海200127
28.06.2021
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1674-8115 |
| DOI | 10.3969/j.issn.1674-8115.2021.06.009 |
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| Abstract | R614.2; 目的·观察婴幼儿活体肝移植术中静脉注射顺阿曲库铵的药效学变化.方法·选择终末肝病期需择期行活体肝移植术的婴幼儿16例,年龄6～24个月,美国麻醉师协会(American Society of Anesthesiologists,ASA)分级为Ⅱ级或Ⅳ级.采用TOF-Watch肌松监测仪对尺神经进行连续4个成串刺激(train-of-four,TOF),观察拇内收肌的加速度变化.静脉注射0.15 mg/kg顺阿曲库铵诱导,T1为最大抑制程度时,行气管插管.T1恢复至3％时,输注起始剂量为2μg/(kg·min)的顺阿曲库铵,调节速率,维持90％～95％肌松抑制程度.分别记录注射首剂量顺阿曲库铵后药物的起效时间、TOF无反应期、术中不同分期肌松药的用量;观察停药后患者的肌松恢复情况,包括停药后T1从10％恢复至25％时间、恢复指数(T1从25％恢复至75％的时间)以及4个成串刺激比值(TOFr)=0.9的时间.结果·肝移植术中顺阿曲库铵的平均输注速率为(1.37±0.46)μg/(kg·min);术中无肝前期、无肝期以及新肝期的药物平均输注速率呈现下降趋势,但差异无统计学意义(P=0.110).顺阿曲库铵的起效时间为(242.63±46.74)s,TOF无反应期为(34.02±7.71)min.停药后,T1恢复至25％时间为(12.80±3.49)min,恢复指数为(15.12±4.59)min,TOFr=0.9的时间为(40.27±7.03)min.结论·终末肝病患儿行活体肝移植术时,应充分认识肌松药的药效学特征;使用0.15 mg/kg的顺阿曲库铵麻醉诱导时,应在用药4min后进行气管插管.在麻醉维持阶段,顺阿曲库铵的用药量在3个不同时期基本保持不变,1.4μg/(kg·min)的药物输注速率能提供满意的肌松效果. |
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| AbstractList | R614.2; 目的·观察婴幼儿活体肝移植术中静脉注射顺阿曲库铵的药效学变化.方法·选择终末肝病期需择期行活体肝移植术的婴幼儿16例,年龄6～24个月,美国麻醉师协会(American Society of Anesthesiologists,ASA)分级为Ⅱ级或Ⅳ级.采用TOF-Watch肌松监测仪对尺神经进行连续4个成串刺激(train-of-four,TOF),观察拇内收肌的加速度变化.静脉注射0.15 mg/kg顺阿曲库铵诱导,T1为最大抑制程度时,行气管插管.T1恢复至3％时,输注起始剂量为2μg/(kg·min)的顺阿曲库铵,调节速率,维持90％～95％肌松抑制程度.分别记录注射首剂量顺阿曲库铵后药物的起效时间、TOF无反应期、术中不同分期肌松药的用量;观察停药后患者的肌松恢复情况,包括停药后T1从10％恢复至25％时间、恢复指数(T1从25％恢复至75％的时间)以及4个成串刺激比值(TOFr)=0.9的时间.结果·肝移植术中顺阿曲库铵的平均输注速率为(1.37±0.46)μg/(kg·min);术中无肝前期、无肝期以及新肝期的药物平均输注速率呈现下降趋势,但差异无统计学意义(P=0.110).顺阿曲库铵的起效时间为(242.63±46.74)s,TOF无反应期为(34.02±7.71)min.停药后,T1恢复至25％时间为(12.80±3.49)min,恢复指数为(15.12±4.59)min,TOFr=0.9的时间为(40.27±7.03)min.结论·终末肝病患儿行活体肝移植术时,应充分认识肌松药的药效学特征;使用0.15 mg/kg的顺阿曲库铵麻醉诱导时,应在用药4min后进行气管插管.在麻醉维持阶段,顺阿曲库铵的用药量在3个不同时期基本保持不变,1.4μg/(kg·min)的药物输注速率能提供满意的肌松效果. |
| Author | 周雨曦 殷文 王腾 杭燕南 闻大翔 |
| AuthorAffiliation | 上海交通大学医学院附属仁济医院麻醉科,上海200127 |
| AuthorAffiliation_xml | – name: 上海交通大学医学院附属仁济医院麻醉科,上海200127 |
| Author_FL | ZHOU Yu-xi WANG Teng YIN Wen HANG Yan-nan WEN Da-xiang |
| Author_FL_xml | – sequence: 1 fullname: YIN Wen – sequence: 2 fullname: WANG Teng – sequence: 3 fullname: ZHOU Yu-xi – sequence: 4 fullname: HANG Yan-nan – sequence: 5 fullname: WEN Da-xiang |
| Author_xml | – sequence: 1 fullname: 殷文 – sequence: 2 fullname: 王腾 – sequence: 3 fullname: 周雨曦 – sequence: 4 fullname: 杭燕南 – sequence: 5 fullname: 闻大翔 |
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| Keywords | 婴幼儿 顺阿曲库铵 药效动力学 肝移植 |
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