七氟烷联合静脉麻醉对腹腔镜胃肠肿瘤切除术中罗库溴铵用量的影响  

Influence of sevoflurane combined with continuous intravenous anesthesia on the dosage of rocuronium during laparoscopic gastrointestinal tumor surgery

作　　者：邵刘佳子[1] 郝俊强 万磊[1] 刘邵华[1] 薛富善 SHAO Liu-jia-zi;HAO Jun-qiang;WAN Lei;LIU Shao-hua;XUE Fu-shan(Department of Anesthesiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院麻醉科,北京100050

出　　处：《中华实用诊断与治疗杂志》2023年第1期97-100,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：北京市教育委员会科学研究计划项目(KM202010025021);北京市医院管理局“青苗”计划专项经费资助项目(QML20190101);北京市属医院科研培育项目(PX2019001);中华医学会消化内镜学分会麻醉协作组“人福”科研基金(CSDE022020090001)。

摘　　要：目的观察腹腔镜胃肠肿瘤切除术中采用吸入七氟烷联合静脉麻醉对罗库溴铵用量的影响,探讨其在减少术后不良反应中的作用。方法51例行腹腔镜胃肠肿瘤切除术患者随机分为七氟烷联合静脉麻醉组25例,静脉麻醉组26例。2组均采用静脉注射咪达唑仑0.05mg/kg、舒芬太尼0.4μg/kg、丙泊酚2.5mg/mL、罗库溴铵0.6mg/kg进行麻醉诱导。气管插管后行深度肌松麻醉,静脉泵注丙泊酚3~5mg/(kg·h)和瑞芬太尼0.1~0.3mg/(kg·min),维持术中脑电双频指数值40~60;强直刺激后计数≥3时静脉泵注罗库溴铵,初始剂量为7.5μg/(kg·min),调整静脉泵注速率,维持术中肌松深度强直刺激后计数≤2。七氟烷联合静脉麻醉组气管插管后吸入七氟烷并维持最低肺泡有效浓度为1.0;静脉麻醉组不吸入七氟烷。2组均于预计手术结束前40min停止泵注罗库溴铵,静脉泵注丙泊酚和瑞芬太尼至术毕;七氟烷联合静脉麻醉组在预计手术结束前30min停止吸入七氟烷。记录2组瑞芬太尼、丙泊酚、罗库溴铵等用量,拔管时间,手术时间,PACU治疗时间,肌松起效时间,临床肌松时间,体内作用时间,恢复指数;采用莱顿手术评分量表评定手术开始(T_(0))、手术开始后1h(T_(1))、停止泵注罗库溴铵(T_(2))、关闭腹腔(T_(3))时肌松效果;观察2组术后恶心呕吐、心动过缓、拔管后呼吸困难、低氧血症等不良反应发生情况。结果2组年龄、性别比例、身高、体质量指数、ASA分级及肿瘤部位比较差异均无统计学意义(P>0.05)。七氟烷联合静脉麻醉组瑞芬太尼[1.3(1.0,1.7)mg]、丙泊酚[490.0(347.5,740.0)mg]、罗库溴铵[(110.8±38.9)mg]用量均少于静脉麻醉组[2.7(1.5,3.3)mg、1240.0(760.0,1440.0)mg、(140.1±40.9)mg](U=-4.129,P<0.001;U=-4.618,P<0.001;t=-2.622,P=0.012),拔管时间[(67.7±18.9)min]短于静脉麻醉组[(82.1±21.9)min](t=-2.541,P=0.014),2组咪达唑仑、舒芬太尼用量及手术时间、PACU治疗时间、�Objective To observe the influence of sevoflurane inhalation combined with continuous intravenous anesthesia on the dosage of rocuronium in laparoscopic gastrointestinal tumor resection,and to investigate its role in reducing postoperative adverse reactions.Methods Fifty-one patients scheduled for laparoscopic gastrointestinal tumor resection were randomly divided into 25patients receiving sevoflurane combined with intravenous anesthesia(combined anesthesia group)and 26patients receiving intravenous anesthesia(intravenous anesthesia group).Both two groups received induced anesthesia with midazolam(0.05 mg/kg),sufentanil(0.4μg/kg),propofol(2.5 mg/mL),and rocuronium(0.6mg/kg).After tracheal intubation was performed,the patients received deep neuromuscular block.Propofol 3to 5mg/(kg·h)and remifentanil 0.1to 0.3mg/(kg·min)were continuously pumped to maintain the BIS between 40and 60during operation.Rocuronium was intravenously pumped when post-tetanic count was≥3.The initial intravenous pumping rate of rocuronium was 7.5μg/(kg·min)and the venous pump rate was adjusted according to muscle relaxation monitoring results to maintain the depth of post-tetanic count at≤2during operation.Combined anesthesia group inhaled sevoflurane to maintain a 1.0minimum alveolar concentration after tracheal intubation,and intravenous anesthesia group inhaled no sevoflurane.Rocuronium intravenous pumping was stopped 40min before the expected end of operation,and intravenous infusion of propofol and remifentanil was continuous till the end of operation in both groups.Sevoflurane inhaling was stopped 30 min before the end of operation in combined anesthesia group.The dosages of sufentanil,propofol and rocuronium,extubation time,operation duration,length of post-anesthesia care unit stay,muscle relaxant effective time,clinical muscle relaxant time,muscle relaxant action time and muscle relaxant recovery index were recorded.During operation,the Leiden-surgical rating scale(L-SRS)was scored at the beginning of operation(T_(0)),1h aft

关 键 词：胃肠肿瘤 腹腔镜手术 罗库溴铵 七氟烷 深度神经肌肉阻滞 加速康复外科理念 

分 类 号：R614[医药卫生—麻醉学] R735[医药卫生—外科学]