舒更葡糖钠对胸腹腔镜食管癌根治术患者术后肌松恢复的影响

Effects of sugammadex on neuromuscular blockade recovery in patients undergoing thoracoscopic-laparoscopic radical esophagectomy

目的探讨舒更葡糖钠对全麻下胸腹腔镜食管癌根治术患者术后肌松恢复的影响。方法选择全麻下行胸腹腔镜食管癌根治术患者96例,男61例,女35例,年龄18~65岁,ASAⅠ或Ⅱ级。采用随机数字表法将患者分为两组:新斯的明联合阿托品组(C组)和舒更葡糖钠组(S组),每组48例。两组麻醉诱导和术中全麻维持方案相同,使用四个成串刺激(TOF)监测肌松。手术结束后,待肌松监测T2出现时,C组静脉注射新斯的明0.05 mg/kg联合阿托品0.02 mg/kg,S组静脉注射舒更葡糖钠2 mg/kg。记录从给予肌松拮抗药到TOF比值(TOFr)恢复至0.9的时间,从给予肌松拮抗药到拔除气管导管的时间(拔管时间)。计算给予肌松拮抗药后5、15、30 min时肌松残余率。记录术后首次排气、排便时间,记录术后恶心呕吐(PONV)等并发症的发生情况。结果与C组比较,S组TOFr恢复至0.9的时间明显缩短[(2.2±0.9)min vs(16.2±3.4)min,P<0.01],拔管时间明显缩短[(12.3±2.0)min vs(33.0±5.1)min,P<0.01],给予肌松拮抗药后5、15 min时S组肌松残余率明显降低(12%vs 100%、0%vs 65%,P<0.01),S组术后首次排气时间明显缩短[(23.4±2.1)h vs(30.5±3.1)h,P<0.01],PONV发生率明显降低[7例(15%)vs 19例(40%),P<0.05]。两组术后首次排便时间差异无统计学意义。结论舒更葡糖钠用于胸腹腔镜食管癌根治术患者,能更快地逆转罗库溴铵作用下的肌松作用,降低肌松残余发生率,促进患者术后胃肠运动的恢复,减少术后并发症的发生,改善术后肌松恢复质量。

Objective To investigate the effects of sugammadex on neuromuscular blockade recovery in patients with general anesthesia undergoing thoracoscopic-laparoscopic radical esophagectomy.Methods Ninety-six patients with general anesthesia undergoing thoracoscopic-laparoscopic radical esophagectomy were selected,61 males and 35 females,aged 18-65 years,ASA physical statusⅠorⅡ.Patients were divided into two groups:control group(group C)and sugammadex group(group S),48 patients in each group using a random digital table.The two groups received the same anesthesia induction and intraoperative general anesthesia maintenance program,and neuromuscular blockade was assessed with a train-of-four(TOF)stimulus.When T2 of TOF appeared at the end of the surgery,group C received intravenous neostigmine 0.05 mg/kg combined with atropine 0.02 mg/kg,and group S received intravenous sugammadex 2 mg/kg.The time from the administration of neuromuscular blockade antagonists to the recovery of TOF ratio(TOFr)to 0.9,and the time from the administration of neuromuscular blockade antagonists to the extubation(time of extubation)were recorded.The incidence of residual neuromuscular blockade was calculated 5,15,and 30 minutes after administration of neuromuscular blockade antagonists.The time of first postoperative flatus and feces was recorded.The incidence of postoperative nausea and vomiting(PONV)was calculated.Results Compared with group C,the time to restore TOFr to 0.9 was significantly shorter[(2.2±0.9)minutes vs(16.2±3.4)minutes,P<0.01]and the time to extubation was significantly shorter[(12.3±2.0)minutes vs(33.0±5.1)minutes,P<0.01]after the administration of neuromuscular blockade antagonists,and the incidence of residual neuromuscular blockade was significantly lower 5 and 15 minutes after the administration of neuromuscular blockade antagonists(12%vs 100%and 0%vs 65%,P<0.01),the incidence of PONV was significant lower[7 cases(15%)vs 19 cases(40%),P<0.05],and the time to postoperative first flatus was significantly shorter[(23.4±2.1)hours vs(30.5±3.1)hours,P<0.01]in group S.There were no significant differences in the time to postoperative first feces between the two groups.Conclusion Sugammadex can reverse the residual neuromuscular blockade induced by rocuronium within shorter time and decrease the incidence of residual muscular blockade in patients with thoracoscopic-laparoscopic radical esophagectomy,promote the recovery of postoperative gastrointestinal motility,reduce the incidence of postoperative complications and improve the quality of postoperative neuromuscular blockade recovery.