不同肌松程度对腹腔镜胃切除术患者术后早期恢复的影响

Effect of different muscle relaxations on early postoperative recovery in patients undergoing laparoscopic gastrectomy

目的评估深度肌松和中度肌松对腹腔镜胃切除术患者术后早期恢复的影响。方法选择2021年1月至2022年1月行腹腔镜胃切除术的患者79例,男53例,女26例,年龄45~64岁,BMI 18~28 kg/m^(2),ASAⅡ或Ⅲ级。患者随机分为两组:深度肌松组(D组)和中度肌松组(M组),每组40例。D组术中静脉泵注罗库溴铵0.5~0.6 mg·kg^(-1)·h^(-1),维持强直刺激后单次刺激肌颤搐计数(PTC)在1~2次之间。M组术中静脉泵注罗库溴铵0.2~0.3 mg·kg^(-1)·h^(-1),维持四个成串刺激(TOF)保持出现1~2个肌颤搐。记录术中丙泊酚、瑞芬太尼用量,拔管时间、PACU停留时间、首次排气时间、首次排便时间、术后住院时间。于入室即刻、术后24、48 h抽取外周静脉血,检测二胺氧化酶(DAO)和D-乳酸。记录术后恶心呕吐(PONV)、苏醒期躁动、苏醒延迟、术后寒战发生情况。使用手术状态评分评价术者对肌松效果的满意度。结果两组术中丙泊酚、瑞芬太尼用量差异无统计学意义。与M组比较,D组拔管时间明显延长(P<0.05),首次排气时间明显缩短(P<0.05),术后24、48 h的DAO和D-乳酸明显降低(P<0.05)。两组PACU停留时间、首次排便时间、术后住院时间,PONV、苏醒期躁动、苏醒延迟、术后寒战发生率差异无统计学意义。D组手术状态评分明显高于M组(P<0.05)。结论与中度肌松比较,深度肌松能够保护肠黏膜屏障,促进腹腔镜胃切除术患者术后肠道功能的恢复。

Objective To evaluate the effect of deep or moderate muscle relaxation on early postoperative recovery in patients undergoing laparoscopic gastrectomy.Methods Seventy-nine patients,53 males and 26 females,aged 45-64 years,BMI 18-28 kg/m^(2),ASA physical statusⅡorⅢ,who were scheduled to undergo laparoscopic gastrectomy from January 2021 to January 2022 were selected.Patients were randomly assigned to deep muscle relaxation group(group D)or moderate muscle relaxation group(group M).Each group had 40 patients.Patients in group D were given rocuronium 0.5-0.6 mg·kg^(-1)·h^(-1) intravenously during operation,and post-tetanic count(PTC)was maintained between 1 and 2 times after stimulation.Patients in group M were given rocuronium 0.2-0.3 mg·kg^(-1)·h^(-1)intravenously during operation,and 1-2 muscle twitching was maintained by maintaining four train of four stimulation(TOF).Intraoperative propofol and remifentanil dosage,extubation time,PACU stay time,first exhaust time,first defecation time,and postoperative hospital stay were recorded.Venous blood was extracted immediately after entry operating room,24 hours after operation and 48 hours after operation to detect diamine oxidase(DAO)and D-lactic acid.Postoperative nausea and vomiting(PONV),emergence agitation,delayed recovery and postoperative shivering were recorded.Surgical condition score was used to evaluate the satisfaction with muscle relaxation.Results There was no statistical significance in the intraoperative dosage of propofol and remifentanil between the two groups.First exhaust time in group M was significantly longer than that in group D(P<0.05).Extubation time in group M was significantly shorter than that in group D(P<0.05).DAO and D-lactate in group M were significantly higher than those in group D 24 and 48 hours after operation,with a statistical significance(P<0.05).There were no significant differences in duration of PACU stay,first defecation time,hospital stays after surgery,the incidence of PONV,emergence agitation,delayed recovery,and postoperative shivering between the two groups.The surgical condition score of group D was significantly higher than that of group M(P<0.05).Conclusion Compared with moderate muscle relaxation,deep muscle relaxation can protect the intestinal mucosal barrier and promote the recovery of intestinal function after laparoscopic gastrectomy.