摘要神经肌肉阻滞常用于腹腔镜手术,可通过松弛腹壁肌肉,防止突发性肌肉收缩,改善手术条件.而常规采用深度肌松目前仍存在争议,故此就有关评价深度肌松对腹腔镜手术中术野显露和转归影响的临床研究,进行系统性综述-meta分析.文献检索情况:自建库至2016年12月间,收录在Medline、Embase以及Central databases数据库中的临床研究,类型包括随机试验、病例交叉研究和队列研究;共纳入12项评价深度肌松对术野显露影响的临床研究.系统评价的结果表明,与中度肌松比较,深度肌松可优化腹腔镜手术中术野显露[术野显露评分(1-5分)均数差0.65分,95％可信区间0.47～0.83分],且有利于低压气腹的实施.深度肌松还可降低麻醉恢复后疼痛程度[疼痛评分均数差-0.52分,95％可信区间-0.71 ～-0.32分].由此认为,深度肌松可改善腹腔镜手术条件,并降低术后疼痛程度,而可否降低术中并发症发生,改善术后转归,有待进一步研究.本系统性综述的方法学于2016年7月27日在PROSPERO“国际前瞻性系统综述登记平台”预先详述并注册(注册号:CRD42016042144).

abstractsNeuromuscular block (NMB) is frequently used in abdominal surgery to improve surgical conditions by relaxation of the abdominal wall and prevention of sudden muscle contractions.The evidence supporting routine use of deep NMB is still under debate.We aimed to provide evidence for the superiority of routine use of deep NMB during laparoscopic surgery.We performed a systematic review and metaanalysis of studies comparing the influence of deep vs moderate NMB during laparoscopic procedures on surgical space conditions and clinical outcomes.Trials were identified from Medline,Embase,and Central databases from inception to December 2016.We included randomized trials,crossover studies,and cohort studies.Our search yielded 12 studies on the effect of deep NMB on the surgical space conditions.Deep NMB during laparoscopic surgeries improves the surgical space conditions when compared with moderate NMB,with a mean difference of 0.65 [95％ confidence interval (CI):0.47-0.83] on a scale of 1-5,and it facilitates the use of low-pressure pneumoperitoneum.Furthermore,deep NMB reduces postoperative pain scores in the postanaesthesia care unit,with a mean difference of-0.52 (95％ CI:-0.71 to -0.32).Deep NMB improves surgical space conditions during laparoscopic surgery and reduces postoperative pain scores in the postanaesthesia care unit.Whether this leads to fewer intraoperative complications,an improved quality of recovery,or both after laparoscopic surgery should be pursued in future studies.The review methodology was specified in advance and registered at Prospero on July 27,2016,registration number CRD42016042144.