摘要目的 探讨舒更葡糖钠用于胸腔镜肺癌根治术患者拮抗肌松药作用的有效性和安全性.方法 本研究为前瞻性研究.选取2019年3至9月在郑州大学附属肿瘤医院拟行胸腔镜肺癌根治术患者100例,随机数字表法分为对照组(C组)、舒更葡糖钠组(S组).两组患者均进行静脉靶控输注丙泊酚和瑞芬太尼、静脉推注罗库溴铵进行麻醉诱导和维持,脑电双频指数(BIS)监测麻醉深度,肌松监测仪(TOF)检测肌松,双腔导管气管内插管,单肺机械通气,术后患者自控镇痛(PCA).C组患者在关闭胸腔后且有自主呼吸时静脉推注新斯的明(2 mg)联合阿托品(0.5～1.0 mg)逆转肌松药作用;S组在关闭胸腔后TOF计数≥2时(无论有无自主呼吸)静脉推注舒更葡糖钠(2 mg/kg);两组患者均参照拔管指征拔除气管导管.检测麻醉诱导前即刻(T0)、气管插管前即刻(T1)、关闭胸腔后即刻(T2)、术后1 h(T3)、术后6h(T4)、术后24 h(T5)、术后48 h(T6)患者平均动脉压,心率,V3导联心电图的QT间期,血清谷丙转氨酶(ALT),谷草转氨酶(AST),肾功能[血尿素氮(BUN)、血肌酐(Cre)]和凝血功能[血浆凝血酶时间(Tr)、血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)],并记录患者的手术时间、气管导管拔除时间、术后48 h内呼吸抑制、呼吸功能障碍、过敏、恶心呕吐、皮肤瘙痒、感觉异常的发生率,以及术后病理分型、术后住院天数等情况.结果 两组患者年龄、性别、体质指数(BMI)、美国麻醉医师协会(ASA)分级、手术时间、术后病理分型、术后住院天数差异均无统计学意义(均P＞0.05);两组患者心率、血压和QT间期差异均无统计学意义(均P＞0.05);两组患者在应用肌松拮抗剂前后血清组胺、肝功能指标(ALT和AST)、肾功能指标(BUN和Cre)差异均无统计学意义(均P＞0.05),相同时间点两组间血清组胺、肝功能指标、肾功能指标差异均无统计学意义(均P＞0.05);两组患者在应用肌松拮抗剂前后出/凝血功能指标(TT、PT、APTT和FIB)差异均无统计学意义(均P＞0.05),相同时间点两组间出/凝血功能指标差异均无统计学意义(均P＞0.05);S组患者术后气管导管拔管时间为(3.7±1.3)min,短于C组患者的(14.5±4.4) min,差异有统计学意义(t=2.266,P＜0.05);两组术后48 h内均无呼吸功能障碍、过敏、皮肤瘙痒和感觉异常患者,术后恶心呕吐发生率两组差异无统计学意义(P＞0.05);术后48 h内C组呼吸抑制患者5例,S组无呼吸抑制患者,差异有统计学意义(x2=5.263,P＜0.05).结论 肺癌根治术患者术毕应用舒更葡糖钠拮抗罗库溴铵的肌松作用是有效的,可以缩短术后气管导管拔管时间.

abstractsObjective To investigate the efficacy and safety of sugammadex for antagonistic neuromuscular block in patients with radical resection of lung cancer under thoracoscope.Methods One hundred patients undergoing radical resection of lung cancer under thoracoscope in Affiliated Cancer Hospital of Zhengzhou University from March to September in 2019,were randomly divided into control group (group C) and sugammadex group (group S).All patients were anaesthetized (induced and maintained) with intravenous target-controlled infusion of propofol and remifentanil,and intermittent intravenous injection of the neuromuscular block of rocuronium.During the operation,the bispectral index (BIS) was used to monitor the depth of anesthesia,and the neuromuscular block was assessed with TOF.Single-lung mechanical ventilation and double-lumen endotracheal intubation were carried out,and patient-controlled analgesia after operation were enforced.Patients in group C received neostigmine (2 mg) combined with atropine (0.5-1.0 mg) after thoracic closure,while patients in group S received sugammadex (2 mg/kg) at TOF count (≥2) after thoracic closure,and then double-lumen endotracheal tubes were extubated according to extubation indications.At these time points:T0 (immediate before anesthesia induction),T1 (immediate before tracheal intubation),T2 (immediately after thoracic closure),T3 (1 h after operation),T4 (6 h after operation),T5 (24 h after operation),T6(48 h after operation),the heart rate(HR) and mean arterial pressure (MAP) were recorded,QT interval (V3 ECG) were measured and calculated,indicators of liver function [alanine transaminase (ALT),aspartate transaminase(AST)],renal function [blood urea nitrogen (BUN),creatinine (Cre)] and clotting function [thrombin time (TT),prothrombin time (PT),activated partial thromboplastin time (APTT) and fibrinogen (FIB)] were detected.The duration of operation,postoperative conditions within 48 hours after operation(the time of tracheal tube extubation,respiratory suppression/dysfunction,allergy,nausea and vomiting,itching of skin,abnormal sensation),pathological types and the postoperative hospital stay were recorded.Results There were no significant differences of the age,sex ratio,body mass index (BMI),American Society of Anesthesiologists (ASA) grading ratio,duration of operation,pathological types and the postoperative hospital stay,HR,MAP and QT interval between two groups (allP＞0.05).There were no remarkable differences of the levels of serum histamine,ALT,AST,BUN,Cre,TT,PT,APTT and FIB before and after administration of neuromuscular blockade antagonists (neostigmine or Sugammadex) in the same group patients (all P＞0.05),also no significant differences between group C and group S at the same time points (all P＞0.05).Average time of tracheal tube extubation in group S [(3.7± 1.3) min] was sharply shorter than that in group C [(14.5±4.4) min,t=2.266,P＜0.05)].There were no patients with allergy,skin itching,sensory abnormality in these two groups.There were no significant difference of the incidence of postoperative nausea and vomiting between these two groups.There were 5 patients with respiratory depression in group C and no respiratory depression patient in group S,the difference was statistically significant between these two groups (x2 =5.263,P＜0.05).Conclusion Sugammadex is effective for antagonizing the neuromuscular blockade of rocuronium in patients with radical resection of lung cancer under thoracoscope,and can shorten the time of tracheal tube extubation after surgery.