舒更葡糖钠与新斯的明肌松拮抗策略对肺叶切除患者肺功能影响效果分析

Effect Analysis of Antagonistic Strategy of Shugeng Sodium Gluconate and Neostigmine on Lung Function in Patients Undergoing Lobectomy

目的:探讨罗库溴铵-舒更葡糖钠与罗库溴铵-新斯的明肌松拮抗策略对肺叶切除术患者肺功能影响效果分析。方法:选取2021年1月至2022年12月于本院行肺叶切除患者86例作为研究对象,按照随机数字表法完全随机分为观察组(予以罗库溴铵-舒更葡糖钠肌松拮抗策)与对照组(予以罗库溴铵-新斯的明肌松拮抗策),每组43例。对比第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、呼气峰流速(PEFR)、去甲肾上腺素(NE)、丙泊酚用量、皮质醇(Cor)、血氧分压(PaO_(2))、瑞芬太尼用量、氧合指数(PaO_(2)/FiO_(2))、术后自主呼吸恢复时间、术后意识恢复时间、肌松拮抗剂起效时间、气管拔管时间、PACU停留时间及术后并发症。结果:重复测量方差分析显示,两组FEV1、FVC、PEFR、NE、Cor、PaO_(2)、PaO_(2)/FiO_(2)存在时间效应、组间效应及时间与组间交互作用均有统计学意义(P<0.05);在术后拔除气管导管后、拔除胸腔引流管后时点,观察组的FEV1、FVC、PEFR高于对照组(P<0.05);在T1、T2、T3时点,观察组的NE、Cor均低于对照组(P<0.05);在切皮时、拔除气管导管前15min、出麻醉后监测治疗室即刻,观察组的PaO_(2)、PaO_(2)/FiO_(2)均高于对照组(P<0.05)。观察组丙泊酚用量、瑞芬太尼用量低于对照组,而术后自主呼吸恢复时间、PACU停留时间、术后意识恢复时间、肌松拮抗剂起效时间、气管拔管时间短于对照组(P<0.05)。观察组的恶心呕吐、寒战、低血压及术后1、7d肺部并发症发生率均低于对照组(P<0.05)。结论:罗库溴铵-舒更葡糖钠肌松拮抗策用于肺叶切除患者中有利于减轻对肺功能的影响,并降低术后并发症发生率。

Objective:To explore the effects of rocuronium-sugammadex and rocuronium-neostigmine reversal strategies on pulmonary function in patients undergoing lobectomy.Methods:Eighty-six patients who underwent lobectomy from January 2021 to December 2022 were selected as the research subjects.They were randomly divided into an observation group(receiving rocuronium-sugammadex reversal strategy)and a control group(receiving rocuronium-neostigmine reversal strategy),with 43 cases in each group.The forced expiratory volume in one second(FEV1),forced vital capacity(FVC),peak expiratory flow rate(PEFR),norepinephrine(NE),propofol(Cor),blood oxygen pressure(PaO_(2)),remifentanil dose,oxygenation index(PaO_(2)/FiO_(2)),postoperative autonomous breathing recovery time,postoperative consciousness recovery time,muscle relaxant onset time,extubation time,post-anesthesia care unit(PACU)stay time,and postoperative complications were compared between the two groups.Results:Repeated measures analysis of variance showed that there were significant time effects,group effects,and time-group interaction effects in FEV1,FVC,PEFR,NE,Cor,PaO_(2),and PaO_(2)/FiO_(2) in both groups(P<0.05).At the time points of tracheal extubation and removal of chest drainage tube,the FEV1,FVC,and PEFR in the observation group were higher than those in the control group(P<0.05).At T1,T2,and T3 time points,NE and Cor in the observation group were lower than those in the control group(P<0.05).At the time of skin incision,15 minutes before extubation,and immediately after leaving the PACU,PaO_(2) and PaO_(2)/FiO_(2) in the observation group were higher than those in the control group(P<0.05).The propofol and remifentanil doses in the observation group were lower than those in the control group,and the postoperative autonomous breathing recovery time,PACU stay time,postoperative consciousness recovery time,muscle relaxant onset time,and extubation time were shorter than those in the control group(P<0.05).The incidence of nausea and vomiting,chills,hypotension,and pulmonary complications on postoperative days 1 and 7 in the observation group was lower than that in the control group(P<0.05).Conclusion:The use of rocuronium-sugammadex for muscle relaxation reversal in patients undergoing lobectomy is beneficial for reducing the impact on pulmonary function and lowering the incidence of postoperative complications.