不同肌松程度对腹腔镜胆囊切除联合胆总管探查术患者视神经鞘直径的影响  

Effect of different neuromuscular blockade on the optic nerve sheath diameter in patients undergoing laparoscopic cholecystectomy combined with common bile duct exploration

作　　者：黎合剑 王祖文 徐国海[1] 肖凡[1] 饶景子 周志东[1] LI Hejian;WANG Zuwen;XU Guohai;XIAO Fan;RAO Jingzi;ZHOU Zhidong(Department of Anesthesiology,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第二附属医院麻醉科,330006

出　　处：《临床麻醉学杂志》2021年第9期924-928,共5页Journal of Clinical Anesthesiology

基　　金：江西省卫健委科技计划项目(202130461);江西省自然科学基金(20202BABL206016)。

摘　　要：目的观察不同肌松程度下腹腔镜胆囊切除联合胆总管探查术患者视神经鞘直径(ONSD)的变化。方法选择2020年6—12月择期全麻下行腹腔镜胆囊切除联合胆总管探查术的患者60例,男33例,女27例,年龄18~64岁,BMI 18~28 kg/m^(2),ASAⅡ级。采用随机数字表法将患者分为两组:深度肌松组(S组)和中度肌松组(Z组),每组30例。术中根据TOF-Watch肌松监测仪,S组维持TOF计数为0且PTC计数1~2,Z组维持TOF计数1~2。记录手术时间、麻醉时间、罗库溴铵用量以及TOFr 0.9时间。记录诱导前即刻(T_(0))、切皮前即刻(T_(1))、气腹后30 min(T_(2))、气腹后1 h(T_(3))、放气后10 min(T_(4))、出手术室前即刻(T_(5))MAP、BIS、HR、ONSD及T_(1)—T_(4)时P_(ET)CO_(2)、PaCO_(2)、CVP。记录术后1 d恶心呕吐、头痛发生情况。结果两组手术时间、麻醉时间以及T_(0)—T_(5)时MAP、HR、BIS、P_(ET)CO_(2)、PaCO_(2)差异无统计学意义。与T_(0)时比较,T_(2)—T_(5)时两组ONSD明显增大(P<0.05)。与T_(1)时比较,T_(2)—T_(4)时两组P_(ET)CO_(2)、PaCO_(2)、CVP均明显升高(P<0.05)。与Z组比较,T_(2)—T_(5)时S组ONSD明显减小(P<0.05),T_(2)—T_(3)时CVP明显降低(P<0.05),TOFr 0.9时间明显延长(P<0.05)。两组术后1 d恶心呕吐、头痛发生率差异无统计学意义。结论与中度肌松比较,深度肌松更能在一定程度上缓解腹腔镜胆囊切除联合胆总管探查术患者术中视神经鞘直径的增大。Objective To observe the changes of optic nerve sheath diameter(ONSD)in patients undergoing laparoscopic cholecystectomy combined with common bile duct exploration under different neuromuscular blockade.Methods Sixty patients underwent laparoscopic cholecystectomy combined with common bile duct exploration under general anesthesia from June to December 2020 were selected,33 males and 27 females,aged 18-64 years,BMI 18-28 kg/m^(2),ASA physical statusⅡ.The patients were randomly divided into deep neuromuscular blockade group(group S)and moderate neuromuscular blockade group(group Z),thirty patients in each group.During the operation,according to the TOF-Watch neuromuscular blockade monitor,the TOF count in group S was maintained aT_(0)and the PTC count was 1-2,and the TOF count in group Z was maintained aT_(1)-2.The operation time,anesthesia time,rocuronium dosage and TOFr 0.9 time of the two groups were recorded.The MAP,BIS,HR,ONSD were recorded immediately before induction(T_(0)),immediately before skin incision(T_(1)),30 minutes after pneumoperitoneum(T_(2)),1 hour after pneumoperitoneum(T_(3)),10 minutes after deflation(T_(4)),immediately before leaving the operating room(T_(5)).P_(ET)CO_(2)2,PaCO_(2),CVP were recorded at T_(1)-T_(4),the incidence of nausea,vomiting,and headache 1 day after operation were also recorded.Results There were no significant differences in operation time,anesthesia time,and MAP,HR,BIS,P_(ET)CO_(2) and PaCO_(2)during T_(0)-T_(5)between the two groups.Compared with T_(0),the ONSD of patients were significantly increased at T_(2)-T_(5)(P<0.05).Compared with T_(1),P_(ET)CO_(2),PaCO_(2)and CVP were also significantly increased in both groups at T_(2)-T_(4)(P<0.05).Compared with group Z,the ONSD of group S was significantly decreased at T_(2)-T_(5)(P<0.05),CVP was significantly decreased at T_(2)-T_(3)(P<0.05),and TOFr 0.9 time was significantly prolonged(P<0.05).There were no significant differences in the incidence of nausea,vomiting,and headache in the two groups 1 day after surgery.C

关 键 词：视神经鞘直径 二氧化碳气腹 胆囊结石 深度肌松 

分 类 号：R614[医药卫生—麻醉学]