舒更葡糖钠对胸腔镜肺切除术后恢复的影响

Effects of sugammadex on postoperative recovery after thoracoscopic pulmonary resection surgery

中文关键词: 舒更葡糖钠  胸腔镜肺切除术  术后肺部并发症  术后恢复

英文关键词: Sugammadex  Thoracoscopic pulmonary resection surgery  Postoperative pulmonary complications  Postoperative recovery

中文摘要:

      
目的：探讨舒更葡糖钠对胸腔镜肺切除术后肺部并发症（PPCs）及术后恢复的影响。
方法：选择2021年11月至2023年7月接受择期胸腔镜肺段切除术或肺叶切除术的患者263例，男112例，女151例，年龄18～64岁，BMI 18.5～28.0 kg/m²，ASAⅠ—Ⅲ级。将患者随机分为三组：舒更葡糖钠组（S组，n=88）、新斯的明组（N组，n=87）和对照组（C组，n=88）。患者术后被送至PACU，当四个成串刺激（TOF）计数为2时，S组静脉注射舒更葡糖钠2 mg/kg，N组静脉注射新斯的明0.04 mg/kg+阿托品0.02 mg/kg，C组静脉注射等容量生理盐水。记录手术结束至出院前PPCs的发生情况，记录手术结束至拔管时间、给药至四个成串刺激比值（TOFr）恢复至0.9的时间、拔管时TOFr、PACU停留时间、拔管后低氧血症（SpO₂<90%）的情况并计算拔管时肌松残余（PRNB）发生率，记录首次下床活动时间、术后48 h内镇痛泵总按压次数、有效按压次数、补救镇痛例数、临床肺部感染评分（CPIS）、术后恶心呕吐（PONV）例数、胸管总引流量、胸管留置时间和术后住院时间。
结果：与C组比较，S组PPCs发生率、拔管时PRNB和拔管后低氧血症发生率明显降低，手术结束至拔管时间、给药至TOFr恢复至0.9的时间、PACU停留时间和术后首次下床活动时间明显缩短，拔管时TOFr明显升高，CPIS评分明显降低（P<0.05）；N组手术结束至拔管时间、给药至TOFr恢复至0.9的时间、PACU停留时间明显缩短，拔管时TOFr明显升高，拔管时PRNB发生率明显降低（P<0.05）。与N组比较，S组拔管时PRNB发生率明显降低，手术结束至拔管时间、给药至TOFr恢复至0.9的时间、PACU停留时间和术后首次下床活动时间明显缩短，拔管时TOFr明显升高（P<0.05）。三组其余指标差异均无统计学意义。
结论：舒更葡糖钠在胸腔镜肺切除术后可快速拮抗残余肌松，降低PPCs和拔管时PRNB发生率，促进患者术后快速康复。

英文摘要:

      
Objective: To investigate the effects of sugammadex on postoperative pulmonary complications (PPCs) and postoperative recovery after thoracoscopic lung resection surgery.
Methods: A total of 263 patients scheduled for thoracoscopic lung resection surgery between November 2021 and July 2023, 112 males and 151 females, aged 18-64 years, BMI 18.5-28.0 kg/m², ASA physical status Ⅰ-Ⅲ, were randomly divided into three groups: the sugammadex group (group S, n = 88), the neostigmine group (group N, n = 87), and the control group (group C, n = 88). The patient was sent to postanesthesia care unit (PACU) after operation, when the train of four (TOF) count reached 2, group S was given sugammadex 2 mg/kg, group N was given neostigmine 0.04 mg/kg + atropine 0.02 mg/kg, and group C was given equal volume of normal saline. The incidence of PPCs from the end of the surgery to the time of discharge was recorded. The time from the end of surgery to extubation, the time from drug administration to recovery of the train of four ratio (TOFr) to 0.9, the TOFr immediately after extubation, the length of stay in PACU, hypoxemia after extubation (SpO₂< 90%) were recorded, and the incidence rate of postoperative residual neuromuscular block (PRNB) was calculated. The time of first getting out of the bed for activity, the number of total and effective compressions by the analgesia pump within 48 hours after surgery, the incidence of rescue analgesia, the clinical pulmonary infection score (CPIS), the numbers of postoperative nausea and vomiting (PONV), total drainage of the chest tube, duration of the chest tube insertion, and the length of postoperative hospital stay were recorded.
Results: Compared with group C, the incidence of PPCs, PRNB and hypoxemia after extubation were significantly decreased, time from the end of surgery to extubation, time from drug administration to recovery of TOFr to 0.9, the length of stay in PACU, and the first postoperatively out of bed activity time were significantly shortened, the TOFr immediately after extubation was significantly increased, and CPIS was significantly decreased in group S (P < 0.05); the time from the end of surgery to extubation, time from drug administration to recovery of TOFr to 0.9, the length of stay in PACU were significantly shortened, the TOFr immediately after extubation was significantly increased, PRNB after extubation were significantly decreased in group N (P < 0.05). Compared with group N, the incidence of PRNB after extubation were significantly decreased, the time from the end of surgery to extubation, the time from drug administration to recovery of TOFr to 0.9, the length of stay in PACU, and the first postoperatively out of bed activity time were significantly shortened, the TOFr immediately after extubation was significantly increased in group S (P < 0.05). There was no significant difference in other indexes between the three groups.
Conclusion: Sugammadex can rapidly antagonize the residual muscle relaxation, decrease the rate of PPCs and PRNB, and promote rapid recovery of patients after thoracoscopic lung resection surgery．