腹腔镜结直肠手术中不同肌松程度对患者术后早期恢复的影响

Efficacy of different degrees neuromuscular blockade in enhancing early postoperative recovery after laparoscopic colorectal surgery

目的探讨不同肌松程度在腹腔镜结直肠手术中对患者术后早期恢复的影响。方法选择行腹腔镜结直肠切除术的患者40例,随机分为深度肌松组(D组)和中度肌松组(M组)。2组在肌松监测下静脉输注苯磺酸顺阿曲库铵,D组维持强直后刺激(PTC)1~2,M组维持4个成串刺激(TOF)1~2。记录2组的术野评估,肌松药情况,肌松恢复指标,术后不良反应及术后早期恢复质量。结果D组术野评估优于M组(P<0.05)。D组肌松药用量多于M组(P>0.05),但D组补药次数少于M组(P<0.05)。2组的拔管时间及持续抬头5 s时间均无统计学差异(P>0.05)。D组术后腹痛和肩痛的发生率低于M组(P<0.05),术后15项恢复质量评分量表(QoR-15)总评分高于M组(P<0.05)。结论深度肌松在腹腔镜结直肠切除术中对术后肌松残余无明显影响,能够为术者提供满意的术野条件,同时可以降低患者的术后疼痛,有助于患者术后的早期恢复。

Objective To investigate the efficacy of different degrees neuromuscular blockade in enhancing early postoperative recovery after laparoscopic colorectal surgery.Methods A total number of 40 patients undergoing laparoscopic colorectal surgery,are randomly divided into two groups of deep neuromuscular blockade(D)group or moderate neuromuscular blockade(M)group.Cis-atracurium was intravenously infused to maintain NMB under monitoring in both groups.Group D maintained post-tetanic count(PTC)of 1 or 2.Group M maintained train-of-four(TOF)count of 1 or 2.The following factors are recorded and evaluated:surgical field condition,use of muscle relax,indicators of muscle relaxation recovery.The occurrence of postoperative adverse reactions and quality of early postoperative recovery were recorded.Results Mean surgical conditions were better for patients allocated to group D than group M(P<0.05).The total amount of muscle relaxants in group D was more than group M(P>0.05),however the number of readministration in group D was less than group M(P<0.05).Additionally theextubation time and head-up duration of 5 s were not statistically significant(P>0.05).The incidence of abdominal pain and shoulder pain in group D was lower than that in group M(P<0.05),and the total score of QoR-15 scale in group D was higher than group M(P<0.05).Conclusion Deep neuromuscular blockade had no significant effect on postoperative muscle relaxation residual,and provides a satisfactory surgical field conditions.Meantime,it can reduce the postoperative pain and improve the early recovery of patients.