舒更葡糖钠对老年患者腹腔镜结直肠癌根治术后早期肺功能的影响

Effect of sugammadex on early postoperative pulmonary function in elderly patients undergoing laparoscopy-assisted colorectal tumor surgery

中文关键词: 舒更葡糖钠  新斯的明  老年  腹腔镜结直肠癌根治术  肺功能

英文关键词: Sugammadex  Neostigmine  Aged  Laparoscopy-assisted colorectal tumor surgery  Pulmonary function

中文摘要:

      
目的 探讨舒更葡糖钠对老年患者腹腔镜结直肠癌根治术后早期肺功能的影响。
方法 选择择期行腹腔镜结直肠癌根治术的老年患者60例，男32例，女28例，年龄65～80岁，BMI 18～28 kg/m²，ASA Ⅰ—Ⅲ级。采用随机数字表法分为两组：舒更葡糖钠组（S组）和新斯的明+阿托品组（NA组），每组30例。术毕进入PACU后，当四个成串刺激（TOF）计数为2时，S组给予舒更葡糖钠2 mg/kg，NA组给予等容积的新斯的明0.02 mg/kg+阿托品0.01 mg/kg，当TOF比值（TOFr）≥0.9时拔除气管导管。记录手术时间、麻醉时间、术中肌松药用量、末次肌松至手术结束时间、手术结束至拔管时间、拮抗后TOFr≥0.9的时间、PACU停留时间、术后住院时间。记录术前、拔管后30 min及拔管后24 h用力肺活量（FVC）、第一秒用力呼气量（FEV₁）及第一秒用力呼气量占所有呼气量的比例（FEV₁/FVC）。记录低氧血症、上呼吸道阻塞、术后肺炎、肺不张、胸腔积液、气胸等肺部并发症发生情况以及术后不良反应发生情况。
结果 两组手术时间、麻醉时间、术中肌松药用量、末次肌松至手术结束时间及术后住院时间差异无统计学意义。S组手术结束至拔管时间、TOFr≥0.9的时间及PACU停留时间明显短于NA组（P＜0.05）。两组术前及拔管后30 min、24 h FVC、FEV₁及FEV₁/FVC差异无统计学意义。两组术后肺部并发症及不良反应发生率差异无统计学意义。
结论 舒更葡糖钠可快速拮抗术后肌松残留，但并未改善老年患者腹腔镜结直肠癌根治术后早期肺功能及降低术后肺部并发症发生率。

英文摘要:

      
Objective To investigate the effect of sugammadex sodium on early postoperative pulmonary function in elderly patients undergoing laparoscopy-assisted colorectal tumor surgery.
Methods Sixty elderly patients underwent elective abdominal surgery, 32 males and 28 females, aged 65-80 years, BMI 18-28 kg/m², ASA physical status Ⅰ-Ⅲ, were randomly divided into two groups: sugammadex sodium group (group S) and neostigmine + atropine group (group NA), 30 patients in each group. After entering PACU, when the train of four stimulation (TOF) count was 2, group S was given sugammadex sodium 2 mg/kg, and group NA was given neostigmine 0.02 mg/kg + atropine 0.01 mg/kg. The endotracheal tube was removed when the ratio of TOF (TOFr) ≥ 0.9. The operation time, anesthesia time, intraoperative muscle relaxants dose used, the time between the last muscle relaxation and the end of the operation, the time between the end of the surgery and extubation time, the time of TOFr ≥ 0.9, the length of stay in PACU and the hospitalization time were recorded. Pulmonary function, including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁) and FEV₁/FVC was tested before surgery, 30 minutes and 24 hours after extubation. Postoperative pulmonary complications (hypoxaemia, upper airway obstruction, postoperative pneumonia, atelectasis, hydrothorax and pneumothorax) and adverse reactions were recorded.
Results There were no differences in operation time, anesthesia time, intraoperative muscle relaxants dose used, the time between the last muscle relaxation and the end of the operation hospitalization time. Compared with group NA, the time from the end of surgery to extubation, the time of TOFr ≥ 0.9 and the length of stay in PACU were shortened significantly in group S. There were no differences in pulmonary function (FVC, FEV₁ and FEV₁/FVC) between the two groups before surgery and 30 minutes and 24 hours after extubation. There were no differences in postoperative pulmonary complications and adverse events between the two groups.
Conclusion Sugammadex sodium can more rapidly antagonize the residual muscle relaxants, but sugammadex sodium does not improve pulmonary function and postoperative pulmonary complications at the early stage after laparoscopy-assisted colorectal tumor surgery in elderly patients.