舒更葡糖钠拮抗不同程度肌松和气腹压对老年腹腔镜胃癌根治术患者呼吸功能的影响  

Effects of sugammadex on respiratory function of elderly gastric cancer patients received laparoscopic radical gastrectomy by antagonizing different degrees of neuromuscular blockade combined with different pneumoperitoneum pressures

作　　者：孙梽均 张益维 黄长顺 SUN Zhijun;ZHANG Yiwei;HUANG Changshun(Health Science Center,Ningbo University,Ningbo 315211,China;不详)

机构地区：[1]宁波大学医学部,315211 [2]宁波大学附属第一医院麻醉科

出　　处：《浙江医学》2024年第18期1968-1973,2008,共7页Zhejiang Medical Journal

基　　金：浙江省卫生健康科技计划项目(2022KY320)。

摘　　要：目的探讨舒更葡糖钠拮抗不同程度肌松和气腹压对老年腹腔镜胃癌根治术患者呼吸功能的影响。方法前瞻性选取2020年3月至2023年6月宁波大学附属第一医院择期行腹腔镜下胃癌根治术的老年患者84例,采用随机数字表法分为深肌松低气腹压组、深肌松常规气腹压组、中度肌松常规气腹压组,每组各28例。术中深肌松低气腹压组维持二氧化碳(CO_(2))气腹压10 mmHg(1 mmHg=0.133 kPa),强直刺激后计数(PTC)1~2个,深肌松常规气腹压组维持CO_(2)气腹压14 mmHg,PTC 1~2个,中度肌松常规气腹压组则维持CO_(2)气腹压14 mmHg,四个成串刺激计数1~2个;术后深肌松低气腹压组、深肌松常规气腹压组患者采用舒更葡糖钠拮抗,中度肌松常规气腹压组则使用新斯的明拮抗。比较3组患者入手术室后(T_(0))、插管后5 min(T_(1))、气腹开始后5 min(T_(2))、气腹后30 min(T_(3))、气腹后1 h(T_(4))、气腹结束5 min(T_(5))的平均动脉压(MAP)、心率(HR)、气道平台压(Pplat)、气道峰压(Ppeak)、动态肺顺应性(Cdyn),以及术后血气分析指标(pH、PaO_(2)、PaCO_(2))、拔管时间、肌松恢复时间、拔管后麻醉复苏室(PACU)发生呼吸不良事件、术后肺部并发症(PPCs)、术后住院时间。结果3组患者各时点的MAP、HR比较差异均无统计学意义(均P>0.05),但随着麻醉时间的增加,3组患者的MAP、HR均较麻醉前有明显降低(均P<0.05)。深肌松低气腹压组患者在T_(2)、T_(3)、T_(4)时点的Pplat、Ppeak较深肌松常规气腹压组、中度肌松常规气腹压组低,而Cdyn较高,差异均有统计学意义(均P<0.05),同时3组患者在T_(2)、T_(3)、T_(4)时点的Pplat、Ppeak均较T_(1)、T_(5)时点高,Cdyn较T_(1)、T_(5)时点低,差异均有统计学意义(均P<0.05)。深肌松低气腹压组、深肌松常规气腹压组患者的拔管时间、肌松恢复时间较中度肌松常规气腹压组短,PACU呼吸不良事件较中度肌松常规气腹压组少,差异均�Objective To investigate the effect of sugammadex on respiratory function of elderly gastric cancer patients received laparoscopic radical gastrectomy by antagonizing different degrees of neuromuscular blockade combined with different pneumoperitoneum pressures.Methods A total of 84 elderly patients received laparoscopic radical gastrec-tomy for gastric cancer in the First Affiliated Hospital of Ningbo University from March 2020 to June 2023 were selected and divided into group A[deep neuromuscular blockade(NMB)+low-pressure pneumoperitoneum],group B(deep NMB+routine pressure pneumoperitoneum)and group C(moderate NMB+routine pressure pneumoperitoneum)by random number table method,each with 28 patients.During the operation,the CO_(2)pneumoperitoneum pressure and post-tetanic count(PTC)were maintained at 10 mmHg(1 mmHg=0.133 kPa)and 1-2,respectively in group A,while 14 mmHg and 1-2,respectively in group B.In group C,the CO_(2)pneumoperitoneum pressure was maintained at 14 mmHg and train-of-four(TOF)count was maintained at 1-2.After the surgery,patients in groups A and B were antagonized by sugammadex,and in group C,they were antagonized by neostigmine.The three groups were compared in mean arterial pressure(MAP),heart rate(HR),plateau pressure(Pplat),peak pressure(Ppeak),and pulmonary dynamic compliance(Cdyn)while entering the operating room(T_(0)),at 5 min after intubation(T_(1)),5 min after pneumoperitoneum(T_(2)),30 min after pneumoperitoneum(T_(3)),1 h after pneumoperitoneum(T_(4)),and 5 min after the end of pneumoperitoneum(T_(5)),as well as in postoerative blood gas analysis indexes(pH,PaO_(2),PaCO_(2)),extubation time,muscle relaxation recovery time,respiratory adverse events in the postanesthesia care unit(PACU)after extubation,postoperative pulmonary complications(PPCs),and length of postoperative hospital stay.Results There were no significant differences in MAP and HR among the three groups at each time point(all P>0.05).However,after a long period of anesthesia,the MAP and HR were both significantly low

关 键 词：舒更葡糖钠 深肌松 低气腹压 呼吸功能 

分 类 号：R614[医药卫生—麻醉学] R735.2[医药卫生—外科学]