深度肌松对腹腔镜结直肠癌病人术后康复的影响

目的评价深度肌松对腹腔镜结直肠癌病人术后康复的影响。方法择期行腹腔镜结直肠癌手术病人78例，随机分为2组，各39例，分为中度肌松组（A组）和深度肌松组（B组）。A组在肌松监测下泵注苯磺顺阿曲库铵注射液，维持中度肌松；B组在肌松监测下泵注苯磺顺阿曲库铵注射液，维持深度肌松。2组病人术中容量管理均采用目标导向液体治疗策略，入复苏室后继续进行肌松监测，在肌松监测仪指导下给予肌松拮抗药及拔除气管导管。记录并比较2组病人手术视野评分、平均气腹压及平均气道压，恢复指数、拔管时间及复苏室驻留时间，术后疼痛及恶心、呕吐评分，术后早期恢复质量评分、胃肠道功能恢复情况及住院时间。结果B组平均气腹压、平均气道压均低于A组（P < 0.01），B组苯磺顺阿曲库铵使用量、恢复指数、拔管时间均高于A组（P < 0.01）。B组病人术后各时间段肩痛评分均低于A组病人（P < 0.01），术后6、24 h，B组病人内脏痛及恶心呕吐评分均低于A组病人（P < 0.01）。B组术后1、3 d的恢复质量评分均高于A组（P < 0.01）。B组排气时间、排便时间、肠鸣音恢复时间及住院时间均短于A组（P < 0.01）。结论将深度肌松应用于腹腔镜结直肠癌手术中，能够在保证术野的前提下降低气腹压力，提高病人早期恢复质量，促进胃肠道功能恢复，有利于病人术后康复，为围术期麻醉管理提供思路。

Effect of deep neuromuscular blockade on postoperative rehabilitation in patients undergoing laparoscopic colorectal-carcinoma surgery

ObjectiveTo investigate the effect of deep neuromuscular blockade on postoperative rehabilitation of patients undergoing laparoscopic colorectal-carcinoma surgery.MethodsSeventy-eight patients undergoing laparoscopic colorectal-carcinoma surgery were randomly divided into two groups as moderate neuromuscular blockade group(Group A, n=39) and deep neuromuscular blockade group(Group B, n=39).Patients in group A were pumped with cisatracurium under muscle relaxation monitoring to maintain the level of modern neuromuscular blockade.Other patients in group B were pumped with cisatracurium under muscle relaxation monitoring to maintain the level of deep neuromuscular blockade.Goal-directed fluid therapy was performed for intraoperative volume management in both groups.After entering the postanesthesia care unit, neuromuscular blockade monitoring was continued for patients in both groups.Then, muscle relaxation antagonists and extubation of endotracheal tubes were performed in both groups under the guidance of neuromuscular monitoring.The surgical field score, mean pneumoperitoneum pressure, and mean airway pressure were recorded; the time of recovery index, the time of removing the tracheal intubation, and the stay time in the postanesthesia care unit were recorded; the scores of postoperative pain, nausea, and vomiting were recorded; the score of recovery quality scale, recovery of gastrointestinal function, and hospital stay were recorded.ResultsThe mean artificial pneumoperitoneum pressure and mean airway pressure in group B were lower than those in group A(P < 0.01).The usage of cisatracurium, the time of TOF ratio from 0.25 to 0.75, and the time of removing the tracheal intubation in group B were higher than those in group A(P < 0.01).The shoulder pain scores of patients in group B were lower than those in group A at all postoperative periods(P < 0.01).At 6 and 24 hours after operation, the scores of visceral pain, nausea, and vomiting in group B were lower than those in group A(P < 0.01).At 1 and 3 days after operation, the score of recovery quality in group B was higher than that in group A(P < 0.01).The exhaust time, defecation time, bowel sound recovery time and hospital stay in group B were shorter than those in group A(P < 0.01).ConclusionsThe application of deep neuromuscular blockade in laparoscopic colorectal-carcinoma surgery can reduce the pneumoperitoneum pressure under the premise of ensuring the surgical field, improve the early postoperative recovery quality of patients, promote the gastrointestinal function recovery, and benefit the postoperative rehabilitation of patients, providing ideas for perioperative anesthesia management.