浅肌松用于腹腔镜胆囊切除术的可行性.

Objective To explore the feasibility of shallow neuromuscular blockade in laparoscopic cholecystectomy. Methods Sixty-four patients（ASA Ⅰ -Ⅱ），aged 20-60 y，with body mass index of 18-30 kg/m² ，scheduled for elective laparoscopic cholecystectomy，were randomly divided into shallow neuromuscular blockade group（group S，n=32）and moderate neuromuscular blockade group（group M，n= 32）by a random number table.Rocuronium was infused to maintain the degree of neuromuscular blockade in both groups to achieve the target degrees：train-of-four stimulation（TOF）count of 4 in group S and 1~ 3 in group M．Peak airway pressure，airway plateau pressure and compliance of lung（CL）were recorded at following time points：just after tracheal intubation.（T1），10 min after pneumoperitoneum（T2），just end of pneumoperjtoneum（T3）and end of surgery（T4）.Artefial blood samples were collected for blood gas analysis at before induction （T0），T1，T2 and T4. Alveolar-arterial oxygen gradient ［P（A-a）O2］， oxygenation index（OI），intrapulmonary shunt（Qs/Qt）and dead space fraction（VD/VT）were calculated derivatively at T1，T2 and T4.Surgical condition scores were assessed by surgeons，while operation times， extubation times，dosages of rocuronium，usage of muscle relaxant antagonists and adverse reactions during recovery in the two groups were recorded. Results Sixty patients were available for the final statistical analysis，with 30 cases in each group. Compared with group M，CL decreased by nearly 5 mL/cm H2O at T2 in group S，while OI decreased by 40 mmHg and Qs/Qt increased to 12.4%（P<0.01），but there were no significant difference between the two groups at T4. Surgery condition score was lower（P<0.01），however acceptable surgical conditions of group S（83.3%，25/30）has no statistical difference compared with group M（96.7%，29/30），meanwhile extubation time was shorter（P<0.01）and the dosage of rocuronium was less than that of group M （P<0.01），neuromuscular blockade reverse in two groups was statistically significant （P<0.05），There were no significant difference in the other parameters between the two groups. Conclusion Use of shallow neuromuscular blockade in LC has clinical feasibility. [ABSTRACT FROM AUTHOR]