不同肌松深度对腹腔镜袖状胃切除术肥胖症患者视神经鞘直径的影响  

Effect of different muscle relaxation depth on optic nerve sheath diameter in obese patients undergoing laparoscopic sleeve gastrectomy

作　　者：徐文梅 殷文勤 杨万李 林菁艳[1] XU Wenmei;YIN Wenqin;YANG Wanli;LIN Jingyan(Department of Anesthesiology,Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan 637000,China)

机构地区：[1]川北医学院附属医院麻醉科,四川南充637000

出　　处：《重庆医学》2024年第24期3784-3788,共5页Chongqing Medical Journal

摘　　要：目的观察不同肌松深度对行腹腔镜袖状胃切除术的肥胖症患者视神经鞘直径(ONSD)的影响。方法选择2023年3-6月该院择期全身麻醉下行腹腔镜袖状胃切除术的肥胖症患者56例,随机分为深度肌松组(D组)和中度肌松组(M组),每组28例。根据TOF-Watch肌松监测仪,D组维持4个成串刺激(TOF)计数为0且强直后计数(PTC)为1~2,M组维持TOF计数1~2,记录两组手术时间、麻醉时间、罗库溴铵用量,记录诱导插管后5 min(T_(0))、气腹建立后5 min(T_(1))、气腹建立后30 min(T_(2))、气腹建立后90 min(T_(3))、气腹结束后5 min(T_(4))的ONSD、平均动脉压(MAP)、心率(HR)及术后头晕、呕吐等不良反应发生情况。结果两组T_(2)、T_(3)时ONSD差异有统计学意义(P<0.05),D组ONSD较M组明显减小,麻醉时间较M组明显延长(P<0.05),罗库溴铵用量较M组明显增多(P<0.05),两组T_(0)~T_(4)的MAP、HR比较,差异无统计学意义(P>0.05)。1例患者术后出现了严重的低氧血症。结论与中度肌松相比,深度肌松能缓解腹腔镜袖状胃切除术肥胖症患者术中ONSD的增大。Objective To observe the effect of different muscle relaxation depth on optic nerve sheath diameter(ONSD)in obese patients undergoing laparoscopic sleeve gastrectomy.Methods A total of 56 obese patients undergoing elective laparoscopic sleeve gastrectomy under general anesthesia in this hospital from March to June 2023 were selected and randomly divided into the deep muscle relaxation group(group D)and moderate muscle relaxation group(group M),28 cases in each group.According to the TOF-Watch muscle relaxation monitor,group D maintained the train of four(TOF)stimulation count as 0,moreover the post-tetanic count(PTC)count was 1-2,and group M maintained TOF count as 1-2.The operation time,anesthesia time and rocuronium bromide dosage were recorded.ONSD,MAP and HR at 5 min after induction intubation(T_(0)),5 min after pneumoperitoneum establishment(T_(1)),30 min after pneumoperitoneum establishment(T_(2)),90 min after pneumoperitoneum establishment(T_(3)),and 5 min after the end of pneumoperitoneum(T_(4))were recorded,and the occurrence of postoperative adverse reactions such as dizziness and vomiting were recorded.Results There were statistical differences in ONSD at T_(2) and T_(3) between the two groups(P<0.05),ONSD in the group D was significantly reduced and the anesthetic time was significantly prolonged compared with the group M(P<0.05),the dosage of rocuronium bromide in the group D was significantly increased compared with that in the group M(P<0.05).There was no statistically significant difference in MAP and HR at T_(0)-T_(4) between the two groups(P>0.05).One case developed severe hypoxemia after surgery.Conclusion Compared with moderate muscle relaxation,deep muscle relaxation could alleviate the intraoperative enlargement of ONSD in obese patients undergoing laparoscopic sleeve gastrectomy.

关 键 词：视神经鞘直径 CO_(2)气腹 肥胖 肌松 颅内压 

分 类 号：R614.2[医药卫生—麻醉学]