不同肌松程度对行腹腔镜结直肠癌根治术老年患者围手术期并发症和生存率的影响  

Effect of different muscle relaxation degree on perioperative complications and survival rate of elderly patients undergoing laparoscopic colorectal cancer resection

作　　者：修天宇 韩佳育 安奕 李丽霞 赵磊[1] Xiu Tianyu;Han Jiayu;An Yi;Li Lixia;Zhao Lei(Department of Anesthesiology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院麻醉手术科,北京100053

出　　处：《国际麻醉学与复苏杂志》2024年第11期1157-1162,共6页International Journal of Anesthesiology and Resuscitation

基　　金：国家自然科学基金(62376168);北京市医院管理中心“培育计划”(PX2022033)。

摘　　要：目的比较不同肌松程度对行腹腔镜结直肠癌根治术老年患者围手术期并发症和生存率的影响。方法选择行择期腹腔镜结直肠癌根治术的患者60例,按随机数字表法分为2组(每组30例):中度肌松组(M组)和深度肌松组(D组)。两组患者均于全凭静脉麻醉下行腹腔镜结直肠癌根治术,M组维持四个成串刺激(TOF)计数1~2,术中气腹压力维持在12~14mmHg(1mmHg=0.133kPa),D组维持TOF计数为0且强直刺激后单刺激计数1~2,术中气腹压力维持在8~10mmHg,两组患者其他麻醉用药和术中麻醉管理方案相同,术后均采用患者自控镇痛。记录两组患者一般资料[性别比、年龄、体重指数(BMI)、美国麻醉医师协会(ASA)分级、麻醉时间]。记录术中丙泊酚、瑞芬太尼、去甲肾上腺素用量,停药至拔管时间,气腹压力,气腹时间;记录术后住院时间,术后24、48、72h静息和活动时数字分级评分法(NRS)评分,术后24、48、72h术后恶心呕吐(PONV)发生率,术后并发症发生情况;术后2年采用欧洲五维健康量表(EQ5D)评估患者恢复质量,记录EQ-5D指数、总生存期、无进展生存期和生存率。结果两组患者一般资料差异无统计学意义(均P>0.05)。两组患者术中丙泊酚、去甲肾上腺素用量,停药至拔管时间,气腹时间差异均无统计学意义(均P>0.05)。D组患者瑞芬太尼用量、气腹压力均低于M组(均P<0.05)。两组患者术后住院时间,术后24、48、72h静息及活动时NRS评分,术后24、48、72hPONV发生率,术后并发症发生情况,术后2年EQ-5D指数、总生存期、无进展生存期、生存率等,差异均无统计学意义(均P>0.05)。结论对于行腹腔镜手术的老年结直肠癌患者,术中维持不同肌松程度并未影响术后并发症发生率和患者的远期生存率,中度肌松和深度肌松均可安全应用。Objective To compare the effect of different levels of neuromuscular blockade on perioperative complications and survival rates in elderly patients undergoing laparoscopic radical resection for colorectal cancer.Methods A total of 60 patients who were scheduled for elective laparoscopic radical resection for colorectal cancer were selected.According to the random number ta-ble method,the patients were divided into two groups(n=30):a moderate neuromuscular blockade group(group M)and a deep neuro-muscular blockade group(group D).Both groups underwent laparoscopic colorectal cancer resection under total intravenous anesthesia.In group M,train-of-four(TOF)counts were maintained at 1-2,with pneumoperitoneum pressure at 12-14 mmHg(1 mmHg=0.133 kPa).In group D,TOF counts were maintained at O,with post-tetanic count of 1-2,and pneumoperitoneum pressure at 8-10 mmHg.Both groups received the same anesthetic agents and intraoperative management protocols,while postoperative patient-contrlled analgesia(PCA)was used.Their general data[gender ratio,age,body mass index(BMI),American Society of Anesthesiologists(ASA)classifica-tion,and anesthesia time]were recorded for both groups.Furthermore,intraoperative propofol,remifentanil,and norepinephrine dosag-es,time from drug withdrawal to extubation,pneumoperitoneum pressure,and pneumoperitoneum duration were also recorded.The length of postoperative hospitalization stay,Numeric Rating Scale(NRS)scores at resting and during exercises at postoperative 24,48 h,and 72 h,the incidence of postoperative nausea and vomiting(PONV)at postoperative 24,48 h,and 72 h,and postoperative complications were recorded.The quality of recovery at postoperative 2 years were evaluated by the EuroQol 5 Dimension(EQ-5D),while EQ-5D index,overall survival(OS),progression-free survival(PFS),and survival rates were recorded.Results There were no statistical differences in general information between the two groups(all P>0.05).There were also no statistical differences between the two groups in intraoperative

关 键 词：老年人 神经肌肉阻滞 围手术期 并发症 生存率 

分 类 号：R735.34[医药卫生—肿瘤] R614[医药卫生—临床医学]