肝癌全身麻醉射频消融术后应用舒更葡糖钠逆转神经肌肉阻滞的回顾性研究

doi:10.16139/j.1007-9610.2023.01.12

摘要/Abstract

摘要：

目的：探讨CT引导肝癌全身麻醉（全麻）射频消融术后、应用舒更葡糖钠逆转神经肌肉阻滞的作用。方法：回顾性分析2019年11月至2022年2月我院220例全麻肝癌射频消融术病人资料。根据不同逆转神经肌肉阻滞类型，即肌松拮抗剂分为：舒更葡糖钠组(S组)108例和新斯的明组(N组)112例。两组病人均采取全凭静脉麻醉，麻醉诱导和维持方式相同。S组术毕静脉给予舒更葡糖钠(2 mg/kg)拮抗肌松，N组静脉给予新斯的明(2 mg)+阿托品(0.5~1 mg)拮抗肌松。比较两组病人自主呼吸完全恢复时间、气管拔管时间、麻醉恢复室(postanesthesia care unit, PACU)停留时间和术后住院时间；以及拔管后10 min CT检查肺不张发生率，术后24 h肝功能，术后肺部并发症发生情况。结果： 与N组比较，S组自主呼吸完全恢复时间、气管拔管时间与PACU停留时间明显缩短(P<0.05)，拔管后10 min肺不张发生率[35例(32.4%)比59例(52.7%)]及术后肺部并发症发生率[4例(3.7%)比11例 (9.8%)]明显降低(P<0.05)。两组术后24 h肝功能指标均较术前明显升高，差异有统计学意义(P<0.05)；组间差异无统计学意义(P>0.05)。结论：舒更葡糖钠有利于快速逆转肝消融病人术后神经肌肉阻滞，降低拔管早期肺不张和术后肺部并发症发生率。

关键词: 舒更葡糖钠, 射频消融, 肝癌, 神经肌肉阻滞

Abstract:

Objective To investigate the effect of sugammadex for reversal of neuromuscular blockade postoperatively in the patients with CT guided radiofrequency ablation of hepatic carcinoma under general anesthesia. Methods The clinical data of 220 patients with radiofrequency ablation of hepatic carcinoma under general anesthesia from November 2019 to February 2022 in our hospital were retrospectively analyzed. Patients were divided into sugammadex group (group S) with 108 patients and neostigmine group (group N) with 112 patients based on choice of neuromuscular blockade reversal. All was by intravenous anesthesia in two groups with same anesthesia induction and maintenance. Group S received intravenous sugammadex 2 mg/kg at the end of the surgery and group N neostigmine 2 mg combined with atropine 0.5-1.0 mg. Time to spontaneous breathing, time of tracheal extubation, period of postanesthesia care unit(PACU) stay and postoperative hospital stay between 2 groups were compared combined with rate of atelectasis examined by CT scan within 10 min after extubation, liver function 24 h postoperatively and pulmonary complication. Results The time to spontaneous breathing, time of extubation, and period of PACU stay in group S decreased significantly compared with those in group N (P<0.05). Both rate of atelectasis [35 (32.4%) vs. 59 (52.7%)]within 10 min after extubation and rate of pulmonary complication [4 (3.7%) vs. 11 (9.8%)] postoperatively decreased (all P<0.05). The liver function 24 h postoperatively in both groups was significantly higher than those before operation (P<0.05) without significant difference between two groups (P>0.05). Conclusions Sugammadex could reverse neuromuscular blockade more quickly and lowering the rates of early postoperative atelectasis and pulmonary complication of the patients with hepatic radiofrequency ablation.

Key words: Sugammadex, Radiofrequency ablation, Hepatic carcinoma, Neuromuscular blockade

中图分类号:

张辉, 龚玲, 郭茜, 罗艳. 肝癌全身麻醉射频消融术后应用舒更葡糖钠逆转神经肌肉阻滞的回顾性研究[J]. 外科理论与实践, 2023, 28(01): 72-76.

ZHANG Hui, GONG Ling, GUO Qian, LUO Yan. Retrospective study on sugammadex for reversal of neuromuscular blockade after radiofrequency ablation of hepatic carcinoma under general anesthesia[J]. Journal of Surgery Concepts & Practice, 2023, 28(01): 72-76.

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Item	Neostigmine group（n=112)	Sugammadex group（n=108)	t/χ² value	P value
Age(years)	59.9 ± 10.6	62.2 ± 9.7	1.03	0.31
Male/females	64/28	60/24	0.22	0.64
Body mass index（kg/m²)	23.1 ± 3.2	23.2 ± 3.0	0.24	0.81
Operative time（min)	91.6 ± 29.4	90.9 ± 30.8	0.11	0.91
Anesthesia time（min)	101.4 ± 29.8	98.8 ± 33.2	0.38	0.71
Amount of rocuronium bromide（mg)	65.1 ± 9.9	64.6 ± 8.9	0.24	0.81
Postoperative hospital stay（d）	4（3，5）	4（3，5）	0.35	0.72

Item	Neostigmine group（n=112)	Sugammadex group（n=108)	z value	P value
Time to spontaneous breathing	12(10，14)	3(3，4)^a)	7.76	<0.01
Time of tracheal extu- bation	18(17，19)	8(7，9)^a)	7.75	<0.01
Period of postanesthe- sia care unit stay	48(42，57)	35(32，38)^a)	7.71	<0.01

Liver function	Neostigmine group（n=112)	Sugammadex group（n=108)	t value	P value
Alanine aminotransfe- rase
Preoperative	32.4±7.7	31.3±13.0	0.02	0.98
24 h postoperative	263.7±62.4^a)	272.2±50.5^a)	0.13	0.89
Aspartate aminotrans- ferase
Preoperative	35.2±12.4	36.9±11.3	0.09	0.93
24 h postoperative	366.8±37.9^a)	353.4±43.6^a)	0.15	0.82

Item	Neostigmine group （n=112)	Sugammadex group （n=108)	χ² value	P value
24 h postoperative pain	8（7.1）	7（6.5）	0.26	0.73
24 h postoperative nau- sea and vomit	7（6.3）	6（5.6）	0.26	0.73
Atelectasis within 10 min after extubation	59（52.7）	35（32.4）^a)	0.53	0.02
Postoperative pulmo- nary complication	11（9.8）	4（3.7）^a)	0.36	0.02