短效性神經肌肉鬆弛劑Mivacurium和Succinylcholine應用於小兒氣管插管之隨機比較研究

Neuromuscular Blockade for Pediatric Tracheal Intubation: A Comparison of Mivacurium and Succinylcholine

張家昇(Chia-Sheng Chang) ； 林國瑞(Kuo-Yuei Lin) ； 張士三(Shin-San Chang) ； 陳坤堡(Kuen-Pao Chen)

《Mid-Taiwan Journal of Medicine》 3卷4期 (1998/12) Pp. 230-236

https://doi.org/10.6558/MTJM.1998.3(4).7

摘要

去極化肌肉鬆弛劑因易引發致命性之惡性高熱、電解質不平衡、不整脈等副作用，美國食品藥物管理局已經宣告除非在緊急插管情況下，不建議使用在大人或小孩身上。但succinylcholine因其作用迅速、藥效短而仍然常使用於小孩氣管內管插管。Mivacurium是一種新的非去極化肌肉鬆弛劑，作用快速、藥效短而不易有殘餘作用，且不須使用抗乙醯膽鹼水解酵素來拮抗肌肉鬆弛劑作用，但此藥使用在小孩之經驗仍少。本試驗係比較在小兒氣管內管插管時使用對95%病患有效劑量（effective dose 95%，ED95）兩倍劑量之mivacurium或同效能劑量之succinylcholine所產生之神經肌肉阻斷深度、插管之優劣、作用時間、藥效恢復時間和副作用。研究對象包括100個年齡介於三個月及兩歲無過敏藥史及禁忌的小孩，以隨機方式分成兩組，分別給予mivacurium 0.25 mg／kg或succinylcholine 1 mg／kg來達到肌肉鬆弛效果。我們利用神經肌肉刺激器（neuromuscular stimulator，NMS）刺激尺神經，於拇內收長肌記錄其基本肌肉張力。當NMS顯示最大阻斷時，記錄作用時間並進行插管，用國際量化之插管評估標準來分析其優劣，每15秒用Train-of-Four（TOF）持續記錄NMS其肌電圖，評估比較其恢復至各種恢復指標之時間。結果顯示mivacurium在小兒氣管內管插管作用速度還是遜於succinylcholine，但是在心律的穩定性優於succinylcholine，而histamine釋放引起的皮膚潮紅和血壓短暫稍微下降的機率尚須和succinylcholine再比較。

關鍵字

小兒氣管插管 ； 神經肌肉傳導刺激器 ； 四連刺激反應

並列摘要

Mivacurium, a new nondepolarizing muscle relaxant, is characterized having a rapid onset of activity and may thus be suitable for rapid-sequence induction of anesthesia. To evaluate the onset and duration of effect of mivacurium and succinylcholime, 100 children, aged 3 to 24 months old, ASA physical status 1 to 2 (based on the American Society of Anesthesiologists classification), were randomly allocated to either receive succinylcholine (1 mg/kg, n=50) or mivacurium (0.25 mg/kg, n=50) before tracheal intubation. The neuromuscular transmission was monitored by electromyography (EMG) at the adductor pollicis muscle of each patient. Muscle activity was evoked by using a neuromuscular stimulator to provide supramaximal stimuli in a train-of-four every 15 seconds to the ulnar nerve. The following variables were recorded for neuromuscular measurement: onset time, maximal block, duration, recovery index, and intubation condition. The onset time of mivacurium was found to be slower than that of succinylcholine (1.5±0.29 vs 0.78±0.15 minutes, ρ＜0.05). The maximal block and intubation conditions were not statistically different between the two groups. The duration time and recovery index showed that mivacurium appears to be more suitable for ambulatory surgery. Offering the priming technique to hasten the onset time could make mivacurium a good alternative for succinylcholine to provide a safer and more effective care for pediatric patients who need tracheal intubation.

並列關鍵字

pediatric tracheal intubation ； mivacurium ； succinylcholine ； neuromuscular stimulator ； train-of-four