舒更葡糖钠与新斯的明对电视胸腔镜肺叶切除术患者预后的影响

袁永瑾; 唐璟; 范忠敏; 马臻杰

doi:10.16766/j.cnki.issn.1674-4152.003624

舒更葡糖钠与新斯的明对电视胸腔镜肺叶切除术患者预后的影响

doi: 10.16766/j.cnki.issn.1674-4152.003624

1.
青海大学附属医院手术麻醉科，青海西宁 810001
2.
大通县妇幼保健院麻醉科，青海西宁 810100

基金项目:

青海省卫生健康委指导性计划课题 2021-wjzdx-59

青海大学附属医院中青年科研基金项目 ASRF-2021-YB-03

详细信息

通讯作者:
马臻杰，E-mail：28813777@qq.com

中图分类号: R614.2 R655.3
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出版历程
- 收稿日期: 2023-06-13
- 网络出版日期: 2024-11-19

Effect of sugammadex sodium and neostigmine on prognosis of patients with video-assisted thoracoscopic lobectomy

1.
Department of Anesthesiology, Affiliated Hospital of Qinghai University, Xining, Qinghai 810001, China

摘要

摘要: 目的术后肌松药残留会导致呼吸功能不全，本研究拟评估舒更葡糖钠与新斯的明对电视胸腔镜肺叶切除术患者罗库溴铵肌松作用的拮抗效果，并评估二者对患者术后肺部并发症的影响。方法选取2021年9月—2022年12月拟在青海大学附属医院行择期电视胸腔镜肺叶切除术的患者共计90例, 按照随机数字表法分为舒更葡糖钠组(S组)和新斯的明组(N组)，每组各45例。S组静脉注射舒更葡糖钠2 mg/kg；N组静脉注射新斯的明0.05 mg/kg(最大剂量5 mg)+阿托品0.02 mg/kg。记录患者拔管时间、麻醉后监护室(PACU)停留时间、术后住院时间和总住院时间；于入PACU后15 min评估患者各部位肌力；比较术后肺部感染等不良反应发生情况。结果 S组拔管时间、PACU停留时间分别为8.1(6.1, 10.9)min、11.8(8.9, 19.7)min，明显短于N组[8.6(6.4, 16.5)min、13.3(10.0, 23.9)min]，差异均有统计学意义(Z=2.089、2.853，P＜0.05)。S组抬头成功人数、握持成功人数明显多于N组，差异有统计学意义(P＜0.05)。S组完成凝视的人数(43例)明显多于N组(38例)，差异均有统计学意义(P＜0.05)。2组术后不良反应发生率比较差异无统计学意义(P＞0.05)。结论与新斯的明相比，舒更葡糖钠更有助于拮抗电视胸腔镜肺叶切除术患者罗库溴铵的肌松效果，但对术后肺部并发症无明显改善。
- 舒更葡糖钠 /
- 新斯的明 /
- 电视胸腔镜肺叶切除术 /
- 罗库溴铵 /
- 肺部并发症
Abstract: Objective Postoperative muscle relaxant residue can lead to respiratory insufficiency, the aim of this study was to evaluate the antagonistic effects of sugammadex sodium and neostigmine on the muscular release of rocuronium in patients undergoing video-assisted thoracoscopic lobectomy, as well as their impact on postoperative pulmonary complications. Methods A total of 90 patients who planned to undergo elective video-assisted thoracoscopic lobectomy in the Affiliated Hospital of Qinghai University from September 2021 to December 2022 were selected, and they were randomly assigned to either the sugammadex sodium group (group S) or neostigmine group (group N) using a random number table method, with 45 cases in each group. Group S was intravenously injected with sugammadex sodium 2 mg/kg, while Group N received an intravenous injection with neostigmine 0.05 mg/kg (maximum dose 5 mg) and atropine 0.02 mg/kg. Extubation time, post-anesthesia cave unit (PACU) stay time, postoperative length of hospitalization, and total length of hospitalization were compared. Muscle strength in each part of the patient was assessed 15 min after admission to PACU. Postoperative pulmonary infection and other adverse reactions were compared. Results The extubation time and PACU residence time in group S were 8.1 (6.1, 10.9) min, 11.8 (8.9, 19.7) min, respectively, which were statistically shorter than those in group N [8.6 (6.4, 16.5) min, 13.3 (10.0, 23.9) min], and the differences were statistically significant (Z=2.089, 2.853, P < 0.05). The number of patients in group S with head raising and holding was significantly higher than that in the N group (P < 0.05). The number of patients in group S who can track object with eyes was statistically higher than that in group N (P < 0.05). There was no significant difference in the incidence of postoperative adverse reactions between 2 groups (P>0.05). Conclusion Compared with neostigmine, sugammadex sodium antagonized the muscle relaxation effect of rocuronium in patients with video-assisted thoracoscopic lobectomy but did not reduce the risk of postoperative pulmonary complications.
- Sugammadex sodium /
- Neostigmine /
- Video-assisted thoracoscopic lobectomy /
- Rocuronium /
- Pulmonary complications

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表 1 2组行择期电视胸腔镜肺叶切除术患者基本资料比较

Table 1. Comparison of basic data of patients undergoing elective video-assisted thoracoscopic lobectomy between the two groups

组别	例数	年龄 (x±s，岁)	性别 (男/女，例)	BMI (x±s)	ASA分级 (Ⅰ~Ⅱ/Ⅲ，例)	吸烟 (例)	高血压 (例)	冠心病 (例)	COPD (例)	心律失常 (例)
S组	43	62.4±6.7	24/19	23.1±3.8	28/15	17	22	22	4	2
N组	44	61.1±6.0	27/17	22.4±3.5	26/18	20	23	18	6	3
统计量		0.954^a	0.276^b	0.894^a	0.335^b	0.312^b	0.011^b	0.921^b
P值		0.343	0.599	0.374	0.563	0.577	0.918	0.337	0.739^c	0.999^c
注: ^a为t值, ^b为χ²值, ^c为采用Fisher精确检验。

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表 2 2组行择期电视胸腔镜肺叶切除术患者围手术期各指标比较

Table 2. Comparison of perioperative indexes of patients undergoing elective video-assisted thoracoscopic lobectomy between the two groups

组别	例数	麻醉时间 (x±s, min)	手术时间 (x±s, min)	拔管时间 [M(P₂₅, P₇₅), min]	PACU停留时间 [M(P₂₅, P₇₅), min]	术后住院时间 (x±s, d)	总住院时间 (x±s, d)
S组	43	208.1±59.4	159.2±34.6	8.1(6.1, 10.9)	11.8(8.9, 19.7)	6.2±0.9	8.5±1.1
N组	44	225.6±66.4	167.9±45.3	8.6(6.4, 16.5)	13.3(10.0, 23.9)	6.6±1.1	8.9±1.3
统计量		1.295^a	1.005^a	2.089^b	2.853^b	1.854^a	1.548^a
P值		0.199	0.318	0.037	0.004	0.067	0.125
注：^a为t值，^b为Z值。

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表 3 2组行择期电视胸腔镜肺叶切除术的患者各部位肌力的比较(例)

Table 3. Comparison of muscle strength of patients undergoing elective video-assisted thoracoscopic lobectomy in different parts between the two groups (cases)

组别	例数	抬头^a	握持^a	伸舌^a	睁眼^a	吞咽	说话	咳嗽	微笑	凝视^a	深呼吸
S组	43	42	41	42	43	43	43	42	43	43	42
N组	44	34	34	37	41	40	40	41	40	38	39
χ²值		8.195	5.976
P值		0.004	0.015	0.058^b	0.241^b	0.116^b	0.116^b	0.616^b	0.116^b	0.026^b	0.202^b
注：^a持续5s以上视为成功; ^b为采用Fisher精确检验。

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表 4 2组行择期电视胸腔镜肺叶切除术的患者术后不良反应比较(例)

Table 4. Comparison of postoperative adverse reactions of patients undergoing elective video-assisted thoracoscopic lobectomy between the two groups (cases)

组别	例数	肺部感染	肺不张	再次插管	持续性肺漏气	低氧血症
S组	43	2	7	0	4	5
N组	44	2	13	1	5	4
χ²值			2.162
P值		0.999^a	0.141	0.999^a	0.999^a	0.739^a
注：^a为采用Fisher精确检验。

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