深度肌松对腹腔镜辅助胃癌根治手术操作条件和肺通气功能的影响  

Effects of Deep Neuromuscular Blockade on Surgical Conditions and Pulmonary Function in Laparoscopic Assisted Radical Gastrectomy

作　　者：李小婷 刘俊乐[1] 陈强[1] 张丹凤 李福源 陈文华[1] LI Xiaoting;LIU Junle;CHEN Qiang;ZHANG Danfeng;LI Fuyuan;CHEN Wenhua(Department of Anesthesiology,Fujian Medical University Union Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院麻醉科,福州350001

出　　处：《福建医科大学学报》2020年第5期327-332,共6页Journal of Fujian Medical University

基　　金：福建省卫生计生委中青年骨干人才培养项目(16-ZQN-ZD-34)。

摘　　要：目的观察深度和中度肌肉松弛(肌松)对腹腔镜辅助胃癌根治手术(LARG)操作条件和肺通气功能的影响。方法选择行LARG的患者40例,采用随机数字表法分为深度肌松组(D组)和中度肌松组(M组),每组各20例。D组维持气腹期间强直刺激后计数(PTC)≤2,当PTC>2时,则单次静脉给予顺式阿曲库铵0.05 mg/kg;M组维持气腹期间4个成串刺激(TOF)为1~2,当TOF计数>2时,则静脉给予顺式阿曲库铵0.025 mg/kg。观察两组患者术前(T 0)、气腹前(T 1)、气腹10 min(T 2)、气腹30 min(T 3)、气腹60 min(T 4)及气腹结束10 min(T 5)的平均气道压(Pmean)、肺动态顺应性(Cdyn)、氧合指数(OI)和呼吸指数(RI)。气腹开始后每30 min记录气腹压力(PP)和手术满意度(SRS),当总分≤3时,腹腔内压力逐步增加2 mmHg(1 mmHg=133.3 Pa),限定范围8~15 mmHg。记录输液量、尿量、气腹时间、手术时间、拔管时间、麻醉恢复室停留期间并发症、术后3 d内肺部感染发生例数以及术后随访情况。结果与M组比较,D组PP低于M组,且SRS高于M组,差别有统计学意义(P<0.05)。与T 1时间点比较,两组气腹期间(T 2~T 4)的Pmean均增大、Cdyn均减小(P<0.05),但D组Pmean增加的幅度和Cdyn下降的幅度均较M组小,差别有统计学意义(P<0.05)。结论LARG气腹期间深度肌松能改善手术操作条件,改善肺顺应性和平均气道压,并在术后康复上与中度肌松无显著差别。Objective To investigate the effects of deep and moderate neuromuscular blockade(DNMB)on surgical conditions and pulmonary function in laparoscopic assisted radical gastrectomy(LARG).Methods Forty patients undergoing LARG were randomly allocated to deep neuromuscular blockade group(group D)and moderate neuromuscular blockade group(group M),20 in each group.We adjusted the depth of neuromuscular blockade under the guidance of neuromuscular blockade monitor,so that Post Tetanic Count(PTC)in group D was less than 2 and Train-of-Four(TOF)in group M was 1-2.Arterial blood gas analysis was performed,and mean airway pressure(Pmean)and pulmonary dynamic compliance(Cdyn)were recorded at T 1-T 5.Pneumoperitoneal pressure was recorded every 30 minutes after the introduction of trocar,and surgical rating scale(SRS)was assessed every 30 minutes until the cease of pneumoperitoneum.When the SRS score≤3,the intra-abdominal pressure was gradually increased by 2 mmHg under the condition that the neuromuscular blockade requirements of each group were met.We limited the range of IAP to between 8 and 15 mmHg.Total input,urine output,duration of operation,time to extubation,complications during postanesthesia care unit(PACU)stay,and the cases of pulmonary infection within 3 days after operation were recorded.We also record the postoperative information,such as length of hospital stay,etc.Results There were no significant differences in the one-second rate(FEV 1/FVC),operation time,extubation time,and postoperative outcomes between the two groups(P>0.05).Compared with the M group,Pneumoperitoneal pressure in group D was lower than that in group M,and SRS was higher than that in group M(P>0.05).Compared with T 1,the level of Pmean increased and the Cdyn decreased during the process of pneumoperitoneum(T 2-T 4)(P<0.05).But at time T 2-T 4,the change of Cdyn in group D were higher than in group M,and the change of Pmean in group D was less than in group M,and the differences were statistically significant(P<0.05).Conclusions DNMB in LAR

关 键 词：肌松弛 腹腔镜检查 胃肿瘤/外科学 阿曲库铵 

分 类 号：R337.2[医药卫生—人体生理学] R572[医药卫生—基础医学]