【罂粟摘要】深度肌松不能改善七氟烷麻醉患者腹腔镜肾脏手术的手术条件
深度肌松不能改善七氟烷麻醉患者腹腔镜肾脏手术的手术条件
贵州医科大学 高鸿教授课题组
翻译：牛振瑛 编辑：佟睿 审校：曹莹
以丙泊酚作为全身麻醉剂的腹腔镜手术中，深度肌松与改善手术条件有关。然而，在使用挥发性吸入麻醉维持麻醉的情况下，深度肌松是否产生类似的有益效果还没有得到系统的研究。与静脉注射麻醉剂相比，挥发性麻醉剂具有增强肌肉松弛效果的作用，从而潜在地减少对深度肌松的需要，以获得最佳的手术条件。我们研究了七氟烷麻醉期间，深度肌松是否比中度肌松更能改善手术条件。
在这项单中心、前瞻性、随机、双盲研究中，98名计划接受肾脏手术的患者被随机分为2组：深度（PTC计数1-2次）肌松组或中度肌松（TOF计数1-2次）组。术中用七氟烷维持麻醉，使BIS值维持在40到50之间。气腹压力维持在12mmHg。主要观察指标是手术条件的差异，由8名不清楚研究方案的外科医生中的一名使用莱顿手术评分量表（L-SRS）每隔15分钟对手术区域的质量进行评分，得分1分表示手术条件极差，5分表示手术条件最理想。
深度肌松与中度肌松相比，手术条件无明显改善，手术条件评分的平均值(标准差)分别为4.8(0.3)和4.8(0.4)(P=0.94)。次要观察指标，包括非计划再入院和住院时间延长，两组无显著差异。
七氟烷麻醉期间，在常压腹腔镜肾脏手术中，深度肌松与中肌松相比并不能改善手术条件。
Deep neuromuscular block does not improve surgical conditions in patients receiving sevoflurane anaesthesia for laparoscopic renal surgery
Background: Deep neuromuscular block is associated with improved working conditions during laparoscopic surgery when propofol is used as a general anaesthetic. However, whether deep neuromuscular block yields similar beneficial effects when anaesthesia is maintained using volatile inhalation anaesthesia has not been systematically investigated.Volatile anaesthetics, as opposed to intravenous agents, potentiate muscle relaxation, which potentially reduces the need for deep neuromuscular block to obtain optimal surgical conditions. We examined whether deep neuromuscular block improves surgical conditions over moderate neuromuscular block during sevoflurane anaesthesia.
Methods: In this single-centre, prospective, randomised, double-blind study, 98 patients scheduled for elective renal surgery were randomised to receive deep (post-tetanic count 1-2 twitches) or a moderate neuromuscular block (train-of-four 1-2 twitches). Anaesthesia was maintained with sevoflurane and titrated to bispectral index values between 40 and 50. Pneumoperitoneum pressure was maintained at 12 mm Hg. The primary outcome was the difference in surgical conditions, scored at 15 min intervals by one of eight blinded surgeons using a 5-point Leiden-Surgical Rating Scale (L-SRS) that scores the quality of the surgical field from extremely poor 1to optimal 5.
Results: Deep neuromuscular block did not improve surgical conditions compared with moderate neuromuscular block:mean (standard deviation) L-SRS 4.8 (0.3) vs 4.8 (0.4), respectively (P=0.94). Secondary outcomes, including unplanned postoperative readmissions and prolonged hospital admission, were not significantly different.
Conclusions: During sevoflurane anaesthesia, deep neuromuscular block did not improve surgical conditions over moderate neuromuscular block in normal-pressure laparoscopic renal surgery.
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