罗库溴铵快速顺序诱导用于腹腔镜胆囊切除术的临床研究

Clinical studies of rocuronium rapid sequence induction in patient undergoing laparoscopic cholecystectomy

目的：观察罗库溴铵快速顺序诱导技术在腹腔镜胆囊切除术（LC）麻醉中应用的安全性和有效性。方法选择择期全麻腹腔镜胆囊切除术患者100例，采用随机数字表法分为对照组（C 组）和罗库溴铵快速顺序诱导组（R 组），每组50例。C 组采用常规麻醉诱方法；R 组采用无通气罗库溴铵快速顺序诱导法，患者无自主呼吸后不实施人工辅助通气。记录入室吸空气条件下（T0）、吸氧去氮5 min 时（T1）、插管成功即刻（T2）、机械通气5 min 后（T3）的血氧饱和度（SpO2）、氧分压（PaO2）、二氧化碳分压（PaCO2）、pH 值，记录手术野评级、术中胃管留置情况、手术时间、R 组无通气时间、术中不良反应发生情况。结果T1时点两组患者SpO2、PaO2、pH 较术前明显升高，PaCO2较术前降低（P ＜0．05）。R 组 T2时点与 T1时点比较，PaO2、pH 明显降低，PaCO2明显升高（P ＜0．05），但尚在正常范围；与 C 组比较，R 组 T2时点 PaO2、pH 明显降低，PaCO2明显升高（P ＜0．05）。机械通气5 min 后两组患者 PaCO2、pH 水平均恢复至术前水平（P ＞0．05），吸氧去氮后各时点 SpO2、PaO2均高于术前（P ＜0．05）。两组患者手术时间比较差异无统计学意义（P ＞0．05），R 组患者手术视野评级优于 C 组（P ＜0．05），胃管留置率明显低于 C 组（P ＜0．05）。结论罗库溴铵快速顺序诱导技术用于腹腔镜胆囊切除术可为手术创造更好的操作条件和手术视野，可安全用于临床。

Objective To observe the safety and efficacy of rocuronium rapid sequence induction in patient undergoing laparoscopic cholecystectomy（LC）.Methods 100 patients undergoing laparoscopic cholecystectomy were randomly divided into two groups（n =50）：control group（group C）and rocuronium rapid sequence induction group （group R）.Conventional induction of anesthesia was used in group C,rocuronium rapid sequence induction was used in group R and assisted ventilation was not implemented in the induction process.Oxygen saturation（SpO2 ）,partial pressure of oxygen（PaO2 ）,carbon dioxide partial pressure（PaO2 ）,pH were recored at the condition of breathing air （T0 ）,breathing pure oxygen 5 minutes（T1 ）,after intubation（T2 ）and mechanical ventilation five minutes（T3 ）.The grade of the exposure in operation field,the operative time,indwelling of gastric suction tube,the time of no ventilation in group R were recorded,too.Results Compared to T1 time point,PaO2 and pH in group R decreased,but PaCO2 was significantly higher at T2 time point（P 〈0.05）;PaO2 and pH in group R were lower,but PaCO2 was significantly higher than group C at T2 time point（P 〈0.05）.After 5 minutes mechanical ventilation,the PaCO2 and pH in two groups were restored to the preoperative level（P 〉0.05）,but SpO2 and PaO2 were higher than preoperative at every time point（P 〈0.05）.The incidence of Indwelling gastric suction tube is higher in group C than in group R,the grade of exposure in the operation field were better in group R than in group C（P 〈0.05）.Conclusion Application of rocuronium rapid sequence induction technique in laparoscopic cholecystectomy can improve the operative conditions and field,it can be safely used in clinical anesthesia.