| 陈珂,王青,李元海.肌松程度对机器人辅助腹腔镜下前列腺癌根治术病人早期术后恢复的影响[J].安徽医药,2019,23(9):1762-1765. |
| 肌松程度对机器人辅助腹腔镜下前列腺癌根治术病人早期术后恢复的影响 |
| Effects of neuromuscular blockade on surgical conditions and early postoperative recovery duringrobotic-assisted laparoscopic radical prostatectomy |
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| DOI：10.3969/j.issn.1009-6469.2019.09.016 |
| 中文关键词: 前列腺切除术 机器人 阿曲库铵 非去极化肌肉松弛药 气腹，人工 神经肌肉阻滞 |
| 英文关键词: Prostatectomy Robotics Atracurium Non-depolarized muscle relaxants Pneumoperitoneum artificial Neuromuscular blockade |
| 基金项目:安徽省科技攻关项目(1301042204) |
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| 摘要点击次数: 2022 |
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| 中文摘要: |
| 目的 探讨不同肌松深度(深度肌松和中度肌松)对机器人辅助腹腔镜下前列腺癌根治术病人早期术后恢复的影响。方法 选取2017年3月至2018年3月安徽医科大学第一附属医院择期性行机器人辅助腹腔镜下前列腺根治术病人40例，年龄范围为54~85岁，体质量指数＜30 kg/m2，美国麻醉医师协会(ASA)分级II~III级。采用随机数字表法分为深度肌松组(D组)20例，中度肌松组(M组)20例。两组均在肌松监测下采用非去极化肌松药维持肌松程度，D组维持肌松程度强直刺激后单刺激肌颤指数1或2，M组维持肌松程度4个成串刺激保持出现1或2个肌颤。记录肌松(TOF)比值恢复至0.7的时间、手术时间、平均气腹压力、平均胸内压(气道峰压和气道平台压)、气管拔管时间、出术后复苏室(PACU)的时间，病人术后肩部疼痛的评分和同一外科医生对手术条件评估“优”和“良”时平均气腹的压力。结果 术中D组平均气腹压、气道峰压和气道平台压分别是(10.5±0.7)mmHg、(20.6±1.1)mmHg、(18.3±1.1)mmHg均低于M组(14.7±1.1)mmHg、(25.7±1.7)mmHg、(23.6±1.1)mmHg(P＜0.05)。D组TOF比值恢复至0.7的时间为(36±12)min，M组为(26±11)min，D组比M组延长(t＝2.747，P＝0.009)，D组肩部疼痛评分(1.8±0.6)分，M组为(3.0±0.3)分，D组比M组评分降低(t＝-8.000，P＜0.001)。气管拔管时间、出PACU的时间无明显变化(t＝0.607， P＝0.547；t＝-0.280，P＝0.781)。结论 深度肌松能降低术中病人平均气道压及术后肩部疼痛的评分，改善病人的早期预后。 |
| 英文摘要: |
| Objective To evaluate the effect of deep and moderate neuromuscular blockade on surgical conditions and early postoperative recovery during robotic-assisted laparoscopic radical prostatectomy.Methods 40 patients，aged 54-85 yr，with body mass index ＜30 kg/m2，ASA II-III，scheduled for elective robotic-assisted laparoscopic radical prostatectomy，were allocated into deep neuromuscular blockade group (group D，n＝20) and moderate neuromuscular blockade group (group M，n＝20) using a random number table.After induction of anesthesia，the patients were intubated and mechanically ventilated.Cisatracurium was continuously infused to maintain the degree of neuromuscular blockade in both groups to achieve the target degree post-tetanic count of 1 or 2 in group D and train-of-four (TOF) count of 1 or 2 in group M.Surgical conditions were assessed and scored after surgery.The time for TOF ratio returning to 0.7，surgery time，intrathoracic pressure，mean intra-abdominal pressure(the same surgeon evaluates the mean pneumoperitoneal pressure when "excellent" and "good" are evaluated for surgical conditions)，extubation time，the time of out the PACU and the sores of postoperative shoulder pain were recorded.Results Compared with group M，the mean intra-abdominal［(20.6±1.1)mmHg vs.(25.7±1.7)mmHg］ and intrathoracic pressure ［(18.3±1.1)mmHg vs.(23.6±1.1)mmHg］ were significantly decreased (P＜0.05)，the incidence of postoperative shoulder pain was decreased ［(1.8±0.6) vs.(3.0±0.3)］(t＝-8.000，P＜0.001)，the time for TOF return time(70%) were prolonged in group D［(36±12)min vs. (26±11)min］(t＝2.747，P＝0.009)，however，the extubation time and the time of out the PACU was no significant change (t＝0.607，P＝0.547；t＝-0.280，P＝0.781).Conclusion Deep neuromuscular blocked can provide better surgical conditions for robotic-assisted laparoscopic radical prostatectomy and shorter recovery time for patients. |
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