Hodges U M
Division of Anaesthetics, United Medical and Dental School, Guy's Hospital, London.
Br J Anaesth. 1996 Jan;76(1):23-8. doi: 10.1093/bja/76.1.23.
Neuromuscular blocking drugs in intensive care units (ICU) may cause complications, including prolonged neuromuscular block as a result of overdosage and post-ventilation muscle weakness. These may be increased by using inappropriately high infusion rates for infants, in whom published studies are scarce, and by failure to monitor neuromuscular block. There is little ICU experience of acceleromyography, which may permit more reliable monitoring. To determine appropriate vecuronium infusion rates, 12 neonates/infants (median age 4 (interquartile range (IQR) 2-5) months) and 18 children (median age 3.07 (2-10 yr) were studied. The vecuronium infusion rate was adjusted to maintain train-of-four (TOF) at 1 response using the TOF guard accelerometer. Recovery time was measured from cessation of infusion until spontaneous TOF ratio recovery of 0.7. Neonates and infants required 45% less vecuronium (mean infusion rate 54.7 (SEM 4.23) micrograms kg-1 h-1) than older children (98.7 (7.07) micrograms kg-1 h-1) and had faster recovery to 70% T4/T1 (45 (IQR 20-51) min vs 65 (55-103) min), with no evidence of prolonged weakness. Routine monitoring of neuromuscular block in ICU is essential; acceleromyography is convenient and reliable.
重症监护病房（ICU）中使用的神经肌肉阻滞剂可能会引发并发症，包括因用药过量导致的神经肌肉阻滞延长以及通气后肌肉无力。对于婴儿而言，由于使用了不恰当的高输注速率（针对婴儿的已发表研究较少）以及未能监测神经肌肉阻滞情况，这些并发症可能会增加。对于可实现更可靠监测的加速度肌电图，ICU的经验很少。为了确定维库溴铵的合适输注速率，对12名新生儿/婴儿（中位年龄4（四分位间距（IQR）2 - 5）个月）和18名儿童（中位年龄3.07（2 - 10岁）进行了研究。使用TOF监护加速度计将维库溴铵输注速率调整至维持四个成串刺激（TOF）出现1次反应。从停止输注开始测量恢复时间，直至自发的TOF比值恢复至0.7。新生儿和婴儿所需的维库溴铵比大龄儿童少45%（平均输注速率54.7（标准误4.23）微克·千克⁻¹·小时⁻¹ 对比 98.7（7.07）微克·千克⁻¹·小时⁻¹），并且恢复至70%的T4/T1更快（45（IQR 20 - 51）分钟 对比 65（55 - 103）分钟），没有出现肌无力延长的证据。在ICU中对神经肌肉阻滞进行常规监测至关重要；加速度肌电图既方便又可靠。
