2024 年第 4 期 第 19 卷

舒更葡糖钠对腹腔镜下胆囊切除术围拔管期血流动力学和相关并发症的影响

Effects of sugammadex on hemodynamics and related complications in patients undergoing periextubation period of laparoscopic cholecystectomy

作者：纪亚男1陈凯2李晓芳1

英文作者：Ji Yanan1 Chen Kai2 Li Xiaofang1

单位：1新疆医科大学第五附属医院麻醉科，乌鲁木齐830011；2新疆医科大学第五附属医院肝胆外科，乌鲁木齐830011

英文单位：1Department of Anesthesiology the Fifth Affiliated Hospital of Xinjiang Medical University Urumqi 830011 China; 2Department of Hepatobiliary Surgery the Fifth Affiliated Hospital of Xinjiang Medical University Urumqi 830011 China

关键词：腹腔镜下胆囊切除术；围拔管期；舒更葡糖钠；血流动力学

英文关键词：Laparoscopiccholecystectomy;Periextubationperiod;Sugammadex;Hemodynamics

• 摘要：

• 目的 探讨舒更葡糖钠对腹腔镜下胆囊切除术围拔管期血流动力学和相关并发症的影响。方法 选取2019年6月至2022年6月于新疆医科大学第五附属医院行腹腔镜下胆囊切除术患者120例，依照随机数字表法分为对照组和观察组，各60例。对照组手术结束后未给予肌松拮抗药物，观察组手术结束后给予舒更葡糖钠静脉滴注。比较2组围拔管期心率、收缩压及舒张压，术前和术后即刻的血清促肾上腺皮质激素（ACTH）、皮质醇水平，术后拔管时间、4个成串刺激计数（TOF）恢复时间、麻醉后监测治疗室（PACU）停留时间及低氧血症发生率、心律失常发生率。结果 对照组拔管后1、5、10 min的心率、收缩压及舒张压均高于拔管前（均P＜0.05）。观察组拔管后1、5、10 min的心率、收缩压及舒张压与拔管前比较差异均无统计学意义（均P＞0.05），且收缩压、舒张压均低于对照组（均P＜0.05）。2组术后即刻血清ACTH、皮质醇水平均高于术前，但观察组均低于对照组（均P<0.05）。观察组术后拔管时间、TOF恢复时间及PACU停留时间均短于对照组［（2.2±1.0）min比（31.1±10.1）min、（55±8）min比（74±12）min、（35±9）min比（48±13）min］（均P<0.001）。观察组术后低氧血症和心律失常发生率均低于对照组［8.3%（5/60）比33.3%（20/60）、1.7%（1/60）比13.3%（8/60）］（均P＜0.05）。结论 在腹腔镜下胆囊切除术后应用舒更葡糖钠能维持患者血流动力学，减轻机体应激反应，并降低拔管后并发症发生率。

• Objective To investigate the effects of sugammadex on hemodynamics and related complications in patients undergoing periextubation period of laparoscopic cholecystectomy. Methods Totally 120 patients with laparoscopic cholecystectomy admitted to the Fifth Affiliated Hospital of Xinjiang Medical University from June 2019 to June 2022 were selected. They were randomly divided into the control group and the observation group, with 60 cases in each group. The control group was not given the muscle relaxant antagonist after the operation, and the observation group was given sugammadex intravenous drip after the operation. The heart rate, systolic blood pressure and diastolic blood pressure of the two groups were compared during periextubation period. The serum levels of adrenocorticotropic hormone (ACTH) and cortisol were compared between the two groups before and immediately after operation. The extubation time, the recovery time of train of four stimulation count (TOF), the length of stay in the post-anesthesia care unit (PACU), and incidences of hypoxemia and arrhythmia were compared between the two groups. Results The heart rate, systolic blood pressure and diastolic blood pressure of the control group were higher at 1, 5 and 10 min after extubation than before extubation（all P＜0.05）. There were no significant differences in heart rate, systolic blood pressure and diastolic blood pressure of the observation group between 1, 5 and 10 min after extubation and before extubation (all P>0.05), and the systolic blood pressure and diastolic blood pressure were lower than those of the control group (both P<0.05). The serum ACTH and cortisol levels immediately after operation in both groups were higher than those before treatment, while the observation group was lower than the control group (all P<0.05). The postoperative extubation time, TOF recovery time, and PACU time of the observation group were significantly shorter than those of the control group ［（2.2±1.0）min vs （31.1±10.1）min, （55±8）min vs （74±12）min, （35±9）min vs （48±13）min］（all P<0.001）. The incidences of postoperative hypoxemia and arrhythmia in the observation group were lower than those in the control group ［8.3%（5/60） vs 33.3%（20/60）, 1.7%（1/60） vs 13.3%（8/60）］(both P<0.05). Conclusion After laparoscopic cholecystectomy, using sugammadex can maintain the hemodynamics of patients, reduce the stress response, and reduce the incidence of complications after extubation.