舒更葡糖钠对胸腔镜肺癌根治术后患者肌松恢复及凝血功能的影响

Effects of sugammadex on neuromuscular blockade recovery and coagulation function in patients after thoracoscopic radical lung cancer surgery

目的探讨舒更葡糖钠注射液对胸腔镜肺癌根治术后患者肌松恢复及凝血功能的影响。方法选取2020年2月至2022年1月在江苏大学附属镇江三院、常州市第七人民医院于全麻下行胸腔镜肺癌根治术的86例患者为研究对象。应用随机数字表法将患者分成A、B两组,每组各43例。两组麻醉诱导和术中全麻维持方案相同,使用肌松监测仪(TOF)监测肌松。手术结束后,TOF计数≥2时,A组静脉推注新斯的明(2 mg/kg)、阿托品(0.5 mg/kg)逆转肌松药,B组静脉推注舒更葡糖钠(2 mg/kg)。记录推注肌松拮抗药后5、15、30 min时肌松残余率。观察注射罗库溴铵后5 min(T0)、推注肌松拮抗药后5 min(T1)、15 min(T2)、30 min(T3)时血浆凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)水平。同时记录气管导管拔除时间及患者发生恶心、呕吐等情况。结果A组给予肌松拮抗药5、15 min后肌松残余率明显高于B组(100.00%vs 13.95%,65.12%vs 0.00%)(χ^(2)=64.939、41.517,P<0.01)。两组患者在相同时间点TT、APTT、PT、FIB指标差异均无统计学意义(P均>0.05)。B组气管导管拔管时间[(3.8±1.1)min]短于A组[(13.9±4.3)min],差异有统计学意义(t=14.922,P<0.001);B组呼吸抑制发生率低于A组(0.00%vs 11.63%)(χ^(2)=5.309,P=0.021)。结论舒更葡糖钠注射液用于胸腔镜肺癌根治术患者,可快速拮抗罗库溴铵的肌松作用,降低肌松残余发生率,缩短气管导管拔管时间,利于患者术后康复。

Objective To investigate the effects of sugammadex on neuromuscular blockade recovery and coagulation function in patients with radical resection of lung cancer under thoracoscope.Methods 86 patients with general anesthesia undergoing thoracoscopic radical esophagectomy were selected from February 2020 to January 2022 in the hospital,the patients were randomly divided into A group and B group.The 2 groups received the same anesthesia induction and intraoperative general anesthesia maintenance program,and neuromuscular blockade was assessed with a train-of-four(TOF)stimulus.When TOF count was≥2,group A received intravenous neostigmine(2 mg/kg)combined with atropine(0.5 mg/kg)and group B received intravenous sugammadex(2 mg/kg).The incidence of residual neuromuscular blockade was calculated 5,15 and 30 minutes after administration of neuromuscular blockade antagonists.The levels of plasma thrombin time(TT),activated partial thromboplastin time(APTT),prothrombin time(PT)and fibrinogen(FIB)were observed at 5 minutes(T0)after injection of rocuronium,5 minutes(T1),15 minutes(T2)and 30 minutes(T3)after administration of neuromuscular blockade antagonists.The time of tracheal catheter removal,nausea and vomiting of the patients were also recorded.Results The incidence of residual neuromuscular blockade in A group was significantly higher than that in B group in the calculated 5 and 15 minutes after administration of neuromuscular blockade antagonists(100.00%vs 13.95%,65.12%vs 0.00%)(χ^(2)=64.939,41.517,P<0.01).There was no significant difference in TT,APTT,PT and FIB between the 2 groups at the same time point(all P>0.05).The extubation time of B group[(3.8±1.1)min]was shorter than that of A group[(13.9±4.3)min],the difference was statistically significant(t=14.922,P<0.001).The incidence of respiratory depression was lower in the B group than that in A[0.00%vs 11.63%](χ^(2)=5.309,P=0.021).Conclusion Sugammadex can reverse the residual neuromuscular blockade induced by rocuronium within shorter time and decreased the incidence of residual muscular blockade in patients with radical resection of lung cancer under thoracoscope,and it can shorten the time of tracheal tube extubation after surgery and promote postoperative recovery.