摘要
目的 比较闭环靶控深度与中度肌松用于妇科腹腔镜手术的效果.方法 本研究为前瞻性研究.选取2020年3月至2021年3月于天津医科大学总医院行择期妇科腹腔镜手术患者50例,年龄18～64岁,BMI 18～30 kg/m2,ASA分级Ⅰ或Ⅱ级,采用计算机随机数字表法分为2组(n=25):TOF闭环靶控中度肌松组(TOF组)和强直刺激后单刺激肌颤搐计数(PTC)闭环靶控深度肌松(PTC组).2组均采用罗库溴铵闭环靶控输注.TOF组肌松程度目标水平为TOF计数1或2,PTC组肌松程度目标水平为PTC计数1或2.记录术者肌松满意度评分、分级及满意率、平均气腹压、罗库溴铵用量、恢复指数、TOF比值恢复至0.9的时间及气管拔管时间.记录术后腹部VAS评分和补救镇痛药物使用情况,记录术后48 h内患者肩痛、手臂痛、恶心、呕吐以及低氧血症等不良反应的发生情况.结果 与TOF组比较,PTC组术者肌松满意度评分、分级和满意率升高,平均气腹压降低,罗库溴铵总用量及平均用量升高,TOF比值恢复至0.9的时间延长,术后腹部VAS评分和氟比洛芬酯使用率降低(P＜0.05),恢复指数、气管拔管时间、术后低氧血症、肩痛、手臂痛及恶心、呕吐的发生率差异无统计学意义(P＞0.05).结论 与闭环靶控中度肌松相比,闭环靶控深度肌松为妇科腹腔镜手术提供了更加满意的手术条件,并降低气腹压力及减少相关并发症发生,且不增加术后不良反应的发生.
Abstract
Objective To compare the efficacy of closed-loop target-controlled deep versus moder-ate neuromuscular blockade in gynecological laparoscopic surgery.Methods This was a prospective study.Fifty American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients,aged 18-64 yr,with body mass index of 18-30 kg/m2,scheduled for elective gynecological laparoscopic surgery in the Gen-eral Hospital of Tianjin Medical University from March 2020 to March 2021,were allocated into 2 groups(n=25 each)using a random number table method:closed-loop target-controlled moderate neuromuscular blockade group(group TOF)and closed-loop target-controlled deep neuromuscular blockade group(group PTC).Rocuronium was given by closed-loop target-controlled infusion in both groups.In group TOF,the tar-get muscle relaxation was considered as train-of-four stimulation(TOF)of 1 or 2.In group PTC,the target muscle relaxation was considered as post-titanic count of 1 or 2.The score for operator's satisfaction with mus-cle relaxation,grading,satisfaction rate,mean pneumo-peritoneum pressure,consumption of rocuronium,re-covery index,recovery time to a TOF ratio 0.9 and time to extubation were recorded.The postoperative visual analogue scale score for abdominal pain and use of rescue analgesics were recorded,and the occurrence of complications such as shoulder pain,arm pain,nausea,vomiting and hypoxemia was also recorded within 48 h after surgery.Results Compared with group TOF,the score for operator's satisfaction with muscle re-laxation,grading and satisfaction rate were significantly increased,the mean pneumo-peritoneum pressure was decreased,the total and average consumption of rocuronium was increased,the recovery time of a TOF ratio 0.9 was prolonged,and the postoperative visual analogue scale score for abdominal pain and usage rate of flurbi-profenate were decreased in group PTC(P＜0.05).There were no significant differences in the recovery index,tracheal extubation time or postoperative incidence of hypoxemia,shoulder pain,arm pain and nausea and vomiting between the two groups(P＞0.05).Conclusions Compared with the closed-loop target-controlled moderate neuromuscular blockade,the closed-loop target-controlled deep neuromuscular blockade provides more satisfactory surgical conditions for gynecological laparoscopic surgery,decreases pneumoperitoneum pres-sure and reduces related complications,without increasing the development of postoperative adverse reactions.
基金项目
吴阶平医学基金会临床科研专项(320.6750.18179)
NETL
NSTL
万方数据