婴幼儿腹腔镜手术中二氧化碳气腹对米库氯铵 作用时间的影响

Effect of carbon dioxide pneumoperitoneum on duration of mivacurium in young children undergoing laparoscopic surgery

摘要:

目的 探讨小儿腹腔镜手术二氧化碳CO2 气腹对米库氯铵作用时间的影响。方法 选取全身 麻醉气管插管下行择期腹股沟疝修补术的61 例患儿，随机分为腹腔镜组（31 例）和开腹组（30 例）。静脉 给予丙泊酚2.5 mg/kg、芬太尼2 μg/kg 及米库氯铵0.2 mg/kg 进行麻醉诱导，术中吸入50% 一氧化二氮 N2O+50% 氧气O2+ 七氟醚维持麻醉，麻醉深度维持在1.2 ～ 1.4 MAC。使用肌松监测仪记录4 个成串刺激（TOF）； 分别记录T1 完全消失时间（Ta）（即肌松药完全起效时间）；T1 消失至T1 恢复到对照值25% 的时间（Tb）（即 肌松药有效作用时间）。检测手术前后24 h 血浆胆碱酯酶（CHE）、谷丙转氨酶（ALT）、谷草转氨酶（AST） 及总胆红素（TBIL）浓度。结果 两组米库氯铵Ta、Tb 比较，差异无统计学意义（P >0.05）；两组术前、术 后24 h 的CHE、ALT、AST 及TBIL 浓度比较，差异无统计学意义（P >0.05）。结论 婴幼儿CO2 气腹米库氯 铵的完全起效时间和有效作用时间无影响。

Abstract:

Objective To investigate the effect of CO2 pneumoperitoneum on the duration of neuromuscular blockade following a single bolus dose of mivacurium in young children undergoing laparoscopic surgery. Methods Totally 61 cases of children (ASA Ⅰ, aged 6 months to 3 years) with selective inguinal hernia repair were randomly divided into laparoscopic surgery group (L group, n = 31) and conventional open surgery group (O group, n = 30). Patients were induced with propofol 2.5 mg/kg, fentanyl 2 μg/kg and mivacurium 0.2 mg intravenously. Anaesthesia was maintained with 50% N2O, 50% oxygen and sevoflurane to maintain a MAC value in the range of 1.2-1.4 MAC. The time of complete disappearance of T1 (Ta) (complete onset time of muscle relaxant) was recorded using TOF stimulation by muscle relaxation monitor; the control time from T1 disappeared to T1 recovery to 25% of the control value (Tb) (effective time of muscle relaxant) were recorded. The levels of plasma cholinesterase (CHE), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBIL) were measured 24 h before and after operation. Results There were no significant differences in the levels of Ta and Tb between the two groups (P > 0.05). There was no significant difference in the levels of CHE, ALT, AST and TBIL between the two groups 24 h before and after operation (P > 0.05). Conclusions The carbon dioxide pneumoperitoneum has no effect on the complete onset time or the effective time in young children.