舒更葡糖钠逆转深度神经肌肉阻滞对腹腔镜术后肺部并发症的影响

The effect of sugammadex reversing deep neuromuscular blockade on postoperative pulmonary complications-after laparoscopy

目的:探讨舒更葡糖钠逆转罗库溴铵深度神经肌肉阻滞对腹腔镜妇科手术患者术后肺部并发症的影响。方法:纳入160例择期接受妇科腔镜手术治疗的患者,随机分为4组,每组各40例,其中A组和B组患者术中间断追加肌松剂罗库溴铵,C组和D组术中持续静脉泵入罗库溴铵,缝皮结束后停用所有麻醉药物,A组和C组患者给予4 mg·kg^(-1)舒更葡糖钠拮抗,B组和D组给予0.02 mg·kg^(-1)新斯的明和0.01 mg·kg^(-1)阿托品拮抗。分别比较A组和B组,C组和D组患者肌松恢复指数、4个成串刺激中第4个肌颤搐与第1个肌颤搐的比值(train of four stimulation ratio, TOFr)恢复至90%时间、拔管时间、术后恢复室停留时间、术后疼痛评分、术后恶心呕吐以及肺部并发症的发生率。结果:A组和C组肌松恢复指数、TOFr恢复至90%时间、拔管时间以及术后恢复室停留时间均短于B组和D组(P<0.05);A组和C组术后疼痛评分、术后恶心呕吐、低氧血症以及肺部并发症的发生率低于B组和D组,差异有统计学意义(P<0.05)。结论:舒更葡糖钠可显著减少妇科腔镜手术患者术后肌松残余的发生,降低术后肺部并发症的发生率。

OBJECTIVE To explore the effect of sugammadex reversing rocuronium deep neuromuscular block on postoperative pulmonary complications in patients undergoing gynecologic laparoscopy.METHODS A total of 160 patients undergoing elective gynecological endoscopy were randomly divided into four groups(n=40 each). In groups A and B, muscle relaxant rocuronium was dosed by an intermittent bonus injection and by continuous infusion in groups C and D. At the end of surgery, dosing of anaesthetics was discontinued. In group A and group C, sugammadex 4 mg·kg^(-1) was dosed and neostigmine 0.02 mg·kg^(-1) plus atropine 0.01 mg·kg^(-1) in groups B and D. Muscle relaxation recovery index, time of train of four stimulation(TOF) ratio of 90%, extubation time, post-anesthesia care unit(PACU) recovery time, incidence of postoperative nausea/vomiting and incidence of postoperative pulmonary complications were compared between groups A and B and groups C and D.RESULTS Recovery time after neuromuscular blockade, time of TOF recovery to 90%, extubation time and PACU recovery time were significantly shorter in group A/C than that in group B/D(P<0.05). The incidence of postoperative nausea, vomiting, hypoxemia, postoperative pain score and postoperative pulmonary complications were markedly lower in group A/C than those in group B/D. And the difference was statistically significant(P<0.05).CONCLUSION Sugammadex can effectively lower the incidence of residual neuromuscular blockade as well as the incidence of postoperative pulmonary complications in patients undergoing gynecological endoscopy.