不同肌松方案对机器人辅助腹腔镜手术患者术后肩痛的影响  

Effect of neuromuscular blockade protocol on postoperative shoulder pain in patients undergoing robot⁃assisted laparoscopic surgery:A single⁃center randomized controlled clinical trial

作　　者：范梅笑 张敏娟 庞沙沙 何珊 路志红 邢东 FAN Meixiao;ZHANG Minjuan;PANG Shasha;HE Shan;LU Zhihong;XING Dong(Department of Anesthesiology and Perioperative Medicine,Xijing Hospital,Air Force Medical University,Xi'an 710032,China;不详)

机构地区：[1]空军军医大学附属西京医院麻醉与围术期医学科,西安710032 [2]空军军医大学附属口腔医院麻醉科,西安710032

出　　处：《实用医学杂志》2024年第17期2460-2464,共5页The Journal of Practical Medicine

基　　金：陕西省中医药管理局课题(编号:SZY-KJCYC-2023-021,2023-ZQNY-001)。

摘　　要：目的 机器人辅助腹腔镜手术在极度头低位下,比较持续深肌松和常规肌松管理方案对患者术后肩痛的影响。方法 选择18~80岁、ASA分级Ⅰ~Ⅱ级,BMI 18~30 kg/m2的机器人辅助腹腔镜手术患者100例,随机分为持续深肌松组(D组)和常规肌松组(C组),每组50例。D组术中维持肌松于强直刺激后计数(post-tetanic count, PTC)1~2,C组术中维持四个成串刺激(train of four stimulation, TOF)值1~2。手术结束时酌情给予舒更葡糖钠拮抗。首要观察指标为术后72 h内肩痛的发生情况,次要观察指标包括术中术野显露Leiden评分、外科医生要求追加肌松次数、术后肌松恢复情况、苏醒期恶心呕吐评分、PACU内及术后24、48、72 h静卧和翻身时的VAS评分、术后肺部并发症发生率、住院时间、患者满意度评分。结果 D组术后出现肩痛的患者较C组显著降低(D组32%vs. C组56%,P <0.05);两组术后肩痛VAS评分差异无统计学意义(P> 0.05)。两组患者术中Leiden评分、外科医师要求追加肌松次数、PACU内恶心呕吐及VAS评分差异无统计学意义(P> 0.05)。术后24 h翻身时的VAS评分D组优于C组(P <0.05);其他时间点静卧及翻身时的VAS评分两组无差异统计学意义(P> 0.05)。两组在术后肺部并发症发生率、住院时间及满意度评分方面差异无统计学意义(P> 0.05)。结论 对于极度头低位下机器人辅助腹腔镜手术患者,术中持续深肌松能降低术后肩痛的发生率。Objective To compare the impact of continuous profound neuromuscular blockade versus con-ventional neuromuscular blockade on postoperative shoulder pain in patients undergoing robot-assisted laparoscopic surgery during steep Trendelenburg position.Methods This study was a single-center,randomized,double-blind clinical trial.The inclusion criteria encompassed individuals aged between 18 and 80 years,with an American Society of Anesthesiologists status ofⅠorⅡ,and a body mass index ranging from 18 kg/m^(2) to 30 kg/m^(2).A total of one hundred patients were randomly assigned to either the deep neuromuscular blockade group(D group)or the conventional neuromuscular blockade group(C group),with equal distribution of fifty cases in each group.Rocuronium dosage was titrated to achieve post-tetanic count values of 1~2 and train-of-four stimulation levels of 1~2 during surgery for D and C groups respectively.At the end of surgery,sugammadex was administered for reversal of neuromuscular blockade.The primary endpoint assessed the incidence of postoperative shoulder pain within three days after surgery.Secondary endpoints included Leiden score evaluation during intraoperative period,number of additional neuromus-cular blockers required by the surgeon,recovery time for muscle relaxation postoperatively,nausea and vomiting scores during recovery phase,visual analog scale(VAS)scores in Post-Anesthesia Care Unit(PACU)as well as within three days after surgery,incidence rate for postoperative pulmonary complications,length of hospital stay duration and patient satisfaction score.Results The incidence of postoperative shoulder pain was significantly lower in group D compared to group C(D group 32%vs.C group 56%;P<0.05).However,there were no significant differences in postoperative shoulder pain VAS scores between the two groups(P>0.05).No significant differences were observed between the groups in terms of Leiden score,surgeon's requirement for additional neuromuscular blockers,nausea and vomiting in PACU,and VAS score(P>0.05)

关 键 词：持续深肌松 常规肌松 极度头低位 术后肩痛 机器人辅助腹腔镜手术 

分 类 号：R614[医药卫生—麻醉学]