滴定输注罗库溴铵用于腹腔镜肝脏手术中深度肌松维持的效果研究

Effect of titrated infusion of Rocuronium bromide on maintenance of deep muscle relaxation during laparoscopic liver surgery

目的:评价滴定输注罗库溴铵用于腹腔镜肝脏手术中深度肌松维持的效果。方法:选取择期肝脏手术患者60例(年龄18~60岁,体重指数<30kg/m2,ASA分级2~3级,肝功能Child-Pugh分级A级或B级),采用随机数表法分为中度肌松弛组(A组,n=30)和深度肌松弛组(B组,n=30)。A组采用间断手动给药法使用罗库溴铵。B组采用滴定法泵注罗库溴铵,目标肌松强度为强直刺激后计数(PTC)为1或2。比较两组的各项手术指标、罗库溴铵总用量、术后肩部VAS疼痛评分和术后并发症的发生情况。结果:与A组比较,B组患者的建立气腹时术野满意度评分、肝脏切除时术野满意度评分、缝合皮肤时术野满意度评分均较高,罗库溴铵总用量较大,气腹压、术后肩部VAS疼痛评分均较低(P<0.05)。两组患者恶心、呕吐、低氧血症发生率的差异无统计学意义(P>0.05)。结论:滴定输注罗库溴铵用于腹腔镜肝脏手术中深度肌松维持的效果较好,且安全性较高,有利于患者的术后恢复。

Objective:To evaluate the efficacy of titrated infusion of rocuronium bromide in the maintenance of deep muscle relaxation during laparoscopic liver surgery.Methods:Sixty patients(age 18-60 years old,body mass index<30kg/m2,ASA grade 2-3,Child-Pugh grade A or B)undergoing selective liver surgery were selected and divided into moderate muscle relaxation group(group A,n=30)and deep muscle relaxation group(group B,n=30)by random number table method.Group A was treated with rocuronium bromide by intermittent manual administration.Group B was pumped with rocuronium bromide by titration,and the target muscle relaxation intensity was 1 or 2 after tetanic stimulation.The surgical indexes,total dosage of rocuronium bromide,postoperative shoulder VAS pain score and postoperative complications were compared between the two groups.Results:Compared with group A,group B had higher operative field satisfaction scores during pneumoperitoneum establishment,liver resection and skin suture,and higher total dosage of rocuronium bromide,lower pneumoperitoneum pressure and postoperative shoulder VAS pain scores(P<0.05).There was no significant difference in the incidence of nausea,vomiting and hypoxemia between 2 groups(P>0.05).Conclusion:Titrated infusion of rocuronium bromide is effective and safe for deep muscle relaxation maintenance in laparoscopic liver surgery,which is beneficial to postoperative recovery of patients.