摘要
目的评价舒更葡糖钠对重度肥胖患者腹腔镜减重手术后恢复质量的影响。方法择期行腹腔镜减重手术患者180例,年龄18~65岁,BMI≥40 kg/m^(2),ASA分级Ⅲ级,采用随机数字表法分为2组(n=90):舒更葡糖钠组(S组)和新斯的明组(N组)。麻醉前行双侧T_(6)、T_(9)椎旁神经阻滞,分别注射0.33%罗哌卡因15 ml。手术结束后待肌松监测T_(2)再现时,S组静脉注射舒更葡糖钠2 mg/kg,N组静脉注射新斯的明0.04 mg/kg+阿托品0.02 mg/kg。转入普通病房后,每12 h静脉注射氟比洛芬酯50 mg;同时采用羟考酮+氟比洛芬酯行PCIA。当疼痛数字评定量表评分≥4分、按压镇痛泵无效时,行双侧T7椎旁神经阻滞补救镇痛,每侧注射0.33%罗哌卡因15 ml。分别于术前和术后24 h时采用QoR-15量表评价术后恢复质量;记录TOF比值≥0.9的时间和气管拔管时间;记录转入PACU时的SpO_(2)、PACU期间最低SpO_(2)及SpO_(2)<92%发生情况;入PACU后30 min时记录肌松残余发生情况和Ramsay镇静评分;记录PACU停留时间、术后首次下床活动时间和住院时间;记录术后48 h内羟考酮累计消耗量、补救镇痛情况和头晕、恶心呕吐、低氧血症、肺部并发症的发生情况。结果2组患者术前及术后24 h时QoR-15总分、术后48 h内羟考酮累计消耗量、补救镇痛率、头晕、恶心呕吐、低氧血症及肺部并发症的发生率差异无统计学意义(P>0.05);与N组比较,S组术后24 h时精力充沛评分、工作活动评分和紧张焦虑评分升高,TOF比值≥0.9时间、气管拔管时间、PACU停留时间、术后首次下床活动时间和住院时间缩短,肌松残余发生率降低(P<0.05)。结论采用舒更葡糖钠拮抗残余肌松,有利于重度肥胖患者腹腔镜减重手术后恢复。
Objective To evaluate the effects of sugammadex on the quality of recovery after laparoscopic bariatric surgery in severely obese patients.Methods One hundred and eighty patients,aged 18-65 yr,with body mass index≥40 kg/m^(2),undergoing elective laparoscopic bariatric surgery,of American Society of Anesthesiologists physical statusⅢ,were enrolled and divided into 2 groups(n=90 each)by the random number table method:sugammadex group(S group)and neostigmine group(N group).Before anesthesia,bilateral T_(6) and T_(9) paravertebral nerve blocks were performed,and 0.33%ropivacaine 15 ml was injected on each side.When the reappearance of T_(2) was monitored under train-of-four(TOF)stimulation after the end of surgery,and sugammadex 2 mg/kg was intravenously injected in S group,and neostigmine 0.04 mg/kg and atropine 0.02 mg/kg were intravenously injected in N group.After the patient was transferred to the general ward,flurbiprofen axetil 50 mg was injected intravenously every 12 h,and oxycodone and flurbiprofen axetil were used for patient-controlled intravenous analgesia at the same time.When the numerical rating scale(NRS)score≥4 and the analgesic pump was ineffective,bilateral T7 paravertebral nerve block was performed for rescue analgesia,and 0.33%ropivacaine 15 ml was injected on each side.The postoperative quality of recovery was assessed by the 15-item Quality-of-Recovery scale before operation and at 24 h after operation.The TOF ratio≥0.9 and extubation time were recorded.The SpO_(2) at the time of transfer to post-anesthesia care unit(PACU),the lowest SpO_(2) and occurrence of SpO_(2)<92%during PACU were recorded.The occurrence of residual muscle relaxation and Ramsay sedation score were recorded at 30 min after entering PACU.The time of PACU stay,time to the first off-bed activity and length of hospital stay were recorded.The cumulative consumption of oxycodone,requirement for rescue analgesia,dizziness,nausea and vomiting,hypoxemia,and pulmonary complications were recorded within 48 h after operation.Results There were no significant differences in the total score of 15-item Quality-of-Recovery scale before surgery and at 24 h after surgery,cumulative consumption of oxycodone within 48 h after surgery,rate of rescue analgesia,and incidence of dizziness,nausea and vomiting,hypoxemia and pulmonary complications between the two groups(P>0.05).Compared with N group,the scores of the three recovery indicators(feel energized with enough rest,engagement in work or family activities,and tension and anxiety)were significanatly increased,time to TOF ratio≥0.9,extubation time,time of PACU stay,time to the first off-bed activity and length of hospital stay were shortened,and the incidence of residual muscle relaxation was decreased in S group(P<0.05).Conclusions Antagonizing residual muscle relaxation with sugammadex is helpful for the recovery of severely obese patients after laparoscopic bariatric surgery.
作者
王琰
杨青
尹岳
马艳玲
储勤军
杨建军
Wang Yan;Yang Qing;Yin Yue;Ma Yanling;Chu Qinjun;Yang Jianjun(Department of Anesthesiology and Perioperative Medicine,Zhengzhou Central Hospital Affiliated To Zhengzhou University,Zhengzhou 450000,China;Department of Anesthesiology and Perioperative Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2022年第8期911-915,共5页
Chinese Journal of Anesthesiology
关键词
舒更葡糖钠
肥胖症
康复
减重手术
Sugammadex
Obesity
Rehabilitation
Bariatric surgery