低温体外循环对婴幼儿顺式阿曲库铵肌松作用的影响

摘要

目的 探讨低温体外循环(CPB)对婴幼儿顺式阿曲库铵肌松作用的影响.方法 选择4个月～3岁先天性心脏病患儿(左向右分流)30例,ASA分级Ⅱ或Ⅲ级.监测四次成串刺激(TOF),全麻诱导给予顺式阿曲库铵0.15 mg/kg,肌颤搐反应强度(T1)最大程度抑制时进行气管插管.T1恢复至75％时静脉注射顺式阿曲库铵0.05 mg/kg.术中观测患儿红细胞压积(Hct)、pH值及体温等；记录CPB前、CPB中和CPB后三阶段T1分别恢复到10％、25％和75％所需时间(T110％、T125％、T175％)及恢复指数(T125％到T175％之间的时间).结果 与CPB之前相比,Hct在CPB中和CPB后降低(P＜0.05);pH值在CPB前、中和后差异无统计学意义(P＞0.05);CPB中的最低温度低于CPB前(P＜0.05),在CPB后温度与CPB前比较差异无统计学意义(P＞0.05).低温CPB中顺式阿曲库铵的T110％、T125％较CPB前延长(P＜0.05)；CPB后顺式阿曲库铵的T1 10％、T1 25％、T1 75％及恢复指数均较CPB前延长(P＜0.05).结论 在婴幼儿低温体外循环中顺式阿曲库铵的作用时间延长、恢复延迟,且在CPB后仍不能恢复至CPB前的水平.%Objective To investigate the influence of hypothermic cardiopulmonary bypass (CPB) on the neuromuscular blocking potency of cisatracurium in infants.Methods Thirty ASA Ⅱ～ Ⅲ children with congenital heart disease,aged 4 months to 3 years,were chosen.Train-of-four (TOF) was used for evaluating the potency of neuromuscular block.Cisatracurium (0.15 mg/kg) was administered and then tracheal intubation was performed when T1 was depressed the most.When T1 of TOF ascended to 75％ of base line,cisatracurium of 0.05 mg/kg was supplemented.The values of intraoperative hematocrit (Hot),pH and temperture were recorded.The duration (T1 10％,25％,75％) and the recovery time (T1 25％～75％) of cisatracurium were measured and recorded pre-,intra-and post-CPB.Results Compared to that of pre-CPB,the values of Hct were significantly lower than that of intra-and post-CPB(P＜0.05).There were no statistically significant differences in pH between each two periods of pre-,intra-and post-CPB (P＞0.05).Minimum temperatures intra-CPB were significantly lower than that of pre-CPB (P＜0.05).There was no statistically significant differences in temperature between pre-CPB and post-CPB (P＞0.05).The durations (T1 10％,25％) of intra-CPB were prolonged compared with those of pre-CPB (P＜0.05).The durations (T1 10％,25％,75％) and the recovery time (T1 25％～75％) of cisatracurium in post-CPB were prolonged compared with those in pre-CPB (P＜0.05).Conclusion Hypothermic cardiopulmonary bypass significantly increased neuromuscular blocking potency of cisatracurium in infants.