1.徐州医科大学附属徐州市儿童医学院 麻醉科,江苏 徐州 221006;2.徐州医科大学 江苏省麻醉学重点实验室,江苏 徐州 221004
1.Department of Anesthesiology, Xuzhou Children’s Hospital, Xuzhou Medical University, Xuzhou, Jiangsu 221006, China;2.Jiangsu Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
目的 探究闭环肌松注射系统T1模式在小儿腹腔镜阑尾切除术中应用的临床效果及安全性。方法 选取2016年1月－2017年1月徐州医科大学附属徐州市儿童医院行腹腔镜阑尾切除术的患儿70例。按照随机数表法将患儿分为实验组和对照组，实验组采用闭环肌松注射系统T1模式给予顺式阿曲库铵，对照组采用肌松恒速注射系统给予顺式阿曲库铵，比较两组患儿手术相关指标、血流动力学指标和肌松监测指标。结果 两组患儿麻醉时间、手术时间和手术过程中体动次数比较，差异均无统计学意义（P > 0.05）；两组患儿麻醉诱导前20 min、插管时、插管后3 min、拔管时和拔管后30 min的平均动脉压（MAP）、心率（HR）和经皮动脉血氧饱和度（SpO2）比较，差异均无统计学意义（P > 0.05）；实验组恢复指数、4个成串刺激比值（TOFr）75和TOFr90明显短于对照组，差异均有统计学意义（P < 0.05）；实验组第1次睁眼时间、持续抬头5 s时间、拔管时间明显短于对照组，差异均有统计学意义（P < 0.05）；实验组顺式阿曲库铵使用总量明显少于对照组（P < 0.05）。两组患儿均未出现明显的不良反应。结论 在小儿腹腔镜阑尾切除术中应用闭环肌松注射系统T1模式安全且有效，能明显减少肌松残余，值得临床推广应用。
Objective To explore the clinical effect and safety of T1 closed-loop muscle relaxation injection mode in pediatric laparoscopic surgery.Methods 70 children underwent laparoscopic appendectomy from January 2016 to January 2017 were selected. The children were randomly divided into experimental group and control group, in the experimental group, cis-atracurium was administered by T1 closed-loop muscle relaxation injection system, in the control group, cis-atracurium was administered by constant-speed injection system. The surgical related indexes, hemodynamic parameters, and muscle relaxation monitoring indicators were compared between the two groups.Results There were no difference in anesthesia time, operation time and number of body movements between the two groups (P > 0.05). There were no difference in mean arterial pressure (MAP), heart rate (HR) and percutaneous arterial oxygen saturation (SpO2) at 20 min before anesthesia induction, intubation, 3 min after intubation, extubation, and 30 min after extubation (P > 0.05). The recovery index, train-of-four ratio (TOFr)75 and TOFr90 of the experimental group were significantly shorter than those of the control group (P < 0.05). The first blinking time, continuous heading time of 5 s, and extubation time in the experimental group were significantly shorter than those of the control group (P < 0.05). The total amount of cis-atracurium in the experimental group was significantly less than that in the control group (P < 0.05). No significant adverse reactions occurred in two groups.Conclusion The application of T1 closed-loop muscle relaxation injection mode in pediatric laparoscopic surgery is safe and effective, and can significantly reduce the residual muscle relaxation, which is worthy of clinical application.