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芬太尼和咪达唑仑不同给药顺序在预防小儿依托咪酯全麻诱导期间所引起肌阵挛的临床观察
Midazolam and fentanyl reduces etomidate-induced myoclonus in children
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DOI:
作者:
魏嵘 王春 章赛吉 刘珺珺 金泉英
WEI Rong, WANG Chun, ZHANG Saiji, LIU Junjun,JIN Quanying
作者单位:
上海市儿童医院 上海交通大学附属儿童医院麻醉科
Department of Anesthesiology,Shanghai Children′s Hospital,Shanghai Jiaotong University
关键词:
芬太尼;咪达唑仑;依托咪酯;小儿;肌阵挛
midazolam;fentanyl;etomidate;children;myoclonus
摘要:
[摘要] 目的 观察芬太尼和咪达唑仑在麻醉诱导期间不同给药顺序对防治小儿依托咪酯所引起肌阵挛的效果。方法 拟在气管插管全麻下择期行腺样体吸割手术儿童80例,年龄≥2岁,美国麻醉医师协会分级(ASA)I-II级。麻醉诱导:咪达唑仑0.1 mg/kg(最大剂量3mg)、芬太尼2 g /kg、依托咪酯0.3 mg/kg(乳剂 江苏恩华药业),随后顺式阿曲库铵0.1mg/kg,肌松达最大阻滞时行气管插管。根据麻醉诱导给药顺序的不同随机分为四组,每组20例:D组:依托咪酯、咪达唑仑、芬太尼; F组:芬太尼、依托咪酯、咪达唑仑;M组:咪达唑仑、依托咪酯、芬太尼;H组:咪达唑仑、芬太尼、依托咪酯。注射依托咪酯后1min内观察肌阵挛发生情况并评分,之后依次注射余下药物。结果 四组患儿间年龄、性别和体重的差异均无统计学意义(P>0.05)。D组注射依托咪酯后有14例患儿出现肌阵挛,发生率为80%;与D组相比F组、M组和H组肌阵挛的发生分级和发生率明显降低(P<0.05),出现肌阵挛的患儿人数分别为7、8和3例,发生率分别为35%、40%和15%;F组和M组之间肌阵挛的发生分级和发生率无统计学差异(P>0.05);H组肌阵挛的发生分级和发生率明显低于M组和F组(P<0.05)。结论 预先使用咪唑安定或芬太尼都可以有效减少依托咪酯诱导所引起肌阵挛的发生,而两药联合应用可以取得更好的效果。
[Abstract] Objective To investigate the effect of midazolam and fentanyl on etomidate-induced myoclonus in children. Methods Eighty children (American Society of Anesthesiologists classⅠ-Ⅱ) who were to undergo OSAHS surgery, were randomly divided into four groups according to the sequence of using anesthetics during anesthesia induction. Three anesthetics were used in this study, and the dosage were as follow: fentanyl 2ug/kg、midazolam 0.1mg/kg、etomidate 0.3mg/kg.Group D: etomidate、midazolam、fentanyl; Group M: midazolam、etomidate、fentanyl; Group F: fentanyl、etomidate、midazolam; and Group H: fentanyl、midazolam、etomidate. After injection of etomidate,the scales incidences of myoclonus were observed 1 minutes later. The occurrence and severity (score 0–3) of myoclonus was defined.and then cisatracurium 0.1mg/kg was given, endotracheal intubation was performed when the muscle was relaxed totally. Results The incidences of myoclonus were 80% in Group D,35% in Group F,40% in Group M and 15% in group H. Compared with Group D , Group F、Group M and group H had lower incidences of myoclonus and scales(P<0.05);and Group H had lower incidences of myoclonus and scales than Group F and Group M(P<0.05);whereas Groups of F and M had no statistical changes in incidences and scales(P>0.05).Conclusions 0.1mg/kg midazolam and 2ug/kg fentanyl is effective drug to reduce etomidate-induced myoclonus in children, and combination of two drugs can achieve better effect.
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