米库氯铵用于小儿患者的有效性和安全性
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The efficacy and safety of mivacurium in pediatric patients
背景与目的
米库氯铵是目前常用的最短效非去极化肌松药; 然而同年龄段儿童静脉注射米库氯铵的不同剂量以及注射时间的效果很少有报道。本研究的目的在于评估小儿患者不同注射时间注射不同剂量的米库氯铵的肌松效果和安全性。
方 法
六百四十例2月-14岁、ASA 分级I或II级的小儿患者，根据年龄段（2–12月，13–35月，3–6岁和7-14岁）将其随机分为四组（A、B、C、D组），每个组又根据诱导剂量分为四个亚组（0.15 0.2mg/kg，用于2–12月年龄段；0.2 0.25mg/kg用于其他三个年龄段），和米库氯铵注射时间（20s、40s），总共分为16个组。用四个成串强直刺激刺激尺神经监测神经肌肉传递。采集桡动脉血（1ml）测量米库氯铵注射前以及注射后1, 4，和7min时的血浆组胺浓度（P0，P1，P2和P3）。
结 果
五百六十二例小儿患者完成了这项研究。 四组之间没有人口统计学差异。 在2-12月年龄段的小儿患者注射0.2 mg / kg米库氯铵组起效时间短于0.15 mg / kg米库氯铵组（189±64 s vs 220±73 s，181±60 s vs 213±71 s，P <0.05），恢复时间无统计学差异。3-6岁年龄段组患者注射0.2 mg / kg米库氯铵组T1 25％恢复时间短于0.25 mg / kg米库氯铵组（693±188 s vs 800±206 s，P <0.05）。 13-35月和7-14岁年龄段的小儿患者米库氯铵的起效时间和恢复时间没有差异。 四组P0，P1，P2，P3的血浆组胺浓度无差异。
结 论
米库氯铵的诱导剂量和注射时间对其起效时间和恢复时间没有显着影响。 但例外的是，在2-12月年龄段的小儿患者中，将米库氯铵的剂量从0.15mg / kg增加到0.2mg / kg能将起效时间缩短约30秒。 研究剂量的米库氯铵在任何年龄段的小儿患者中不产生明显的组胺释放。
原始文献摘要
Ruifeng Zeng1, Xiulan Liu1,5, Jing Zhang1, Ning Yin2,6, Jian Fei2, Shan Zhong2, Zhiyong Hu3, Miaofeng Hu3,Mazhong Zhang4, Bo Li4, Jun Li1, Qingquan Lian1 and Wangning ShangGuan1 The efficacy and safety of mivacurium in pediatric patients BMC Anesthesiology (2017) 17:58 DOI 10.1186/s12871-017-0350-2
Background: Mivacurium is the shortest acting nondepolarizing muscle relaxant currently available; however, the effect of different dosages and injection times of intravenous mivacurium administration in children of different ages has rarely been reported. This study was aimed to evaluate the muscle relaxant effects and safety of different mivacurium dosages administered over different injection times in pediatric patients.
Methods: Six hundred forty cases of pediatric patients, aged 2 m-14 years, ASA I or II, were divided into four groups (Groups A, B, C, D) according to the age class (2–12 m, 13–35 m, 3–6 years and 7–14 years) respectively, also each group were divided into four subgroups by induction dose (0.15, 0.2 mg/kg in 2–12 m age class; 0.2, 0.25 mg/kg in other three age classes), and mivacurium injection time (20 s, 40 s), totally 16 subgroups. Neuromuscular transmission was monitored with supramaximal train-of-four stimulation of the ulnar nerve. Radial artery blood (1 ml) was sampled to quantify plasma histamine concentrations before and 1, 4, and 7 min after mivacurium injection (P0, P1, P2 and P3).
Results: Five hundred sixty-two cases completed the study. There were no demographic differences within the four groups. The onset time of 0.2 mg/kg groups in 2–12 m aged patients were shorter than those of 0.15 mg/kg groups (189 ± 64 s vs. 220 ± 73 s, 181 ± 60 s vs. 213 ± 71 s, P <0.05), and the recovery times were no statistical differences. The T1 25% recovery time of 0.2 mg/kg in 3–6 years aged patients was shorter than that of 0.25 mg/kg group (693 ± 188 s vs. 800 ± 206 s, P <0.05). The onset and recovery times of mivacurium were not different in 13–35 m and 7–14 years aged patients. The plasma concentrations of histamine at P0, P1, P2 and P3 were not different within four groups.
Conclusions: The induction dose and injection time of mivacurium had mostly insignificant effects on onset and recovery times. The main exception to this was that in 2–12 m aged patients, increasing the dose of mivacurium from 0.15 to 0.2 mg/kg accelerated the onset time by about 30 s. Mivacurium produced no significant release of histamine in any age group at the doses studied.
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