摘要
目的探讨在行肺保护通气策略的腹腔镜胃癌根治术中联合应用深度肌松对术中呼吸力学和术后早期恢复的影响。方法择2019年1月—2020年5月腹腔镜胃癌根治术80例,随机数字表法分为二组各40例。A组麻醉后行肺保护通气,术中维持中等肌松(四个成串刺激TOF=1~2);B组术中行肺保护通气时维持深度肌松(强直刺激后单刺激肌颤搐计数PTC=1~2)。记录二组患者T0(麻醉前)、T1(手术开始前)、T2(气腹15 min后)、T3(停气腹后15 min)时平均动脉压(MAP),心率(HR);T1,T2,T3时气道峰压(Ppeak),平均压(Pmean),肺顺应性(Cdyn),呼气末二氧化碳分压(P_(ET)CO_(2))的数据。记录术中平均气腹压,术后苏醒及肩痛情况等。结果二组患者一般情况、手术时间、输液量、术后拔管时间、出恢复室时间、住院时间差异均无统计学意义(均P>0.05)。B组术中平均气腹压低于A组(P<0.05)。B组患者T2时MAP,HR,Ppeak,Pmean,P_(ET)CO_(2)低于A组(P<0.05),Cdyn高于A组(P<0.05)。B组肌松恢复指数长于A组(P<0.05),术后肩痛发生率,镇痛药物使用量少于A组(P<0.05)。结论行保护性肺通气的腹腔镜胃癌根治术中联合深肌松在提供满意的手术视野空间时平均气腹压更低,循环稳定,肺顺应性高,气道压力低,术后疼痛轻,有利于肺保护及早期恢复。
Objective Toinvestigate the effect of deep muscle relaxation combined with laparoscopic radical resection of gastric cancer with lung protection ventilation strategy on respiratory mechanics and early recovery after operation.Methods The January 2019 to May 2020,eighty cases of laparoscopic radical gastrectomy were randomly divided into two groups,Forty cases respectively.After anesthesia,group A was treated with lung protection ventilation,and the medium neuromuscular blockade was maintained during operation(TOF=1~2);In group B,the deep neuromuscular blockade was maintained during the operation of lung protection ventilation(PTC=1~2).Map and HR were recorded in t0(before anesthesia)T1(before operation)T2(15 min after pneumoperitoneum)T3(15 min after stopping pneumoperitoneum);Data of peak,pmean,cdyn and P_(ET)CO_(2)at T1,T2,T3.The results showed that the patients were all under the same pressure,recovery and shoulder pain.Results There was no significant difference in the general condition,operation time,infusion volume,time of pulling out the tube,time of recovery room and hospitalization time between the two groups(P>0.05).The mean gas abdominal pressure in group B was lower than that in group A(P<0.05).Map,HR,ppeak,pmean and P_(ET)CO_(2)were lower in group B than in group A(P<0.05),and cdyn was higher than that in group A(P<0.05).The recovery index of muscle relaxation in group B was longer than that of group A(P<0.05),and the incidence of shoulder pain was lower than that of group A(P<0.05).Conclusion The combination of deep muscle relaxation and laparoscopic radical resection of gastric cancer with protective pulmonary ventilation is worth popularizing.
作者
乔克坤
李熊刚
张宗泽
QIAO Kekun;LI Xionggang;ZHANG Zongze(Department of Anesthesiology,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)
出处
《中国煤炭工业医学杂志》
2021年第5期470-474,共5页
Chinese Journal of Coal Industry Medicine
基金
中央高校基本科研业务费专项资金(编号:RM003557)
关键词
腹腔镜
肺保护性通气
深度肌松
气腹压
Laparoscopic
Pulmonary protection
Deep neuromuscular blockade
Pneumoperitoneum pressure
