【罂粟摘要】小儿声门上气道短程腹腔镜手术中神经肌肉阻滞对手术条件的影响
贵州医科大学 麻醉与心脏电生理课题组
翻译：牛振瑛 编辑：潘志军 审校：曹莹
在小儿腹腔镜手术中，使用无神经肌肉阻滞的LMA ProSeal™喉罩气道(P-LMA；TELEFLEX)被认为是气管插管的一种安全选择。然而，很少有研究评估使用这种麻醉技术的短程小儿腹腔镜手术的手术条件。我们评估了有或无神经肌肉阻滞时使用P-LMA进行小儿腹腔镜腹股沟疝修补术的手术条件。
66名接受腹腔镜腹股沟疝修补术的患者被随机分为两组，一组使用罗库溴铵的神经肌肉阻滞（TOF计数1-2次），另一组不使用罗库溴铵。所有手术均由同一外科医生进行，该医生使用Leiden-Surgery Rating Scale(L-SRS)确定手术条件。次要结果包括围手术期生命体征监测数据、血流动力学和不良事件。
神经肌肉阻滞改善手术条件：L-SRS评分平均值(标准差)4.1(0.5)vs 3.5(0.6)(P<0.0001)。神经肌肉阻滞组罗库溴铵平均剂量为12.7(4.4±29.7)mg或0.7(0.6±0.8)mg·kg-1。无神经肌肉阻滞组的吸气峰值明显高于神经肌肉阻滞组：吸气峰压平均值(标准差)分别为17.9cmH2O和16.2(1.9cmH2O)(P=0.0004)。无神经肌肉阻滞组有15例(45.5%)在手术和麻醉过程中发生不良反应（包括喉痉挛、支气管痉挛、呼吸暂停、低氧血症、吸气峰压(>20cmH2O)、术中体动、误吸、P-LMA移位），而神经肌肉阻滞组有4例(12.1%)发生不良反应(P=0.006)。
神经肌肉阻滞显著改善了手术条件，减少了在手术和麻醉期间使用LMA Proseal™进行短期儿科腹腔镜手术的不良事件发生率。
Wu L, et al. Effect of neuromuscular block on surgical conditions during short-duration paediatric laparoscopic surgery involving a supraglottic airway[J]. Br J Anaesth. 2021 Aug;127(2):281-288.
英文原文👇
IEffect of neuromuscular block on surgical conditions during short- duration paediatric laparoscopic surgery involving a supraglottic Airway
Abstract
Background:Use of an LMA ProSeal™ laryngeal mask airway (P-LMA; Teleflex) with no neuromuscular block is considered a safe alternative to tracheal intubation in short-duration paediatric laparoscopic surgery. However, few studies have evaluated surgical conditions of short-duration paediatric laparoscopic surgery using this anaesthetic technique. We assessed surgical conditions for paediatric laparoscopic inguinal hernia repair using P-LMA with and without neuromuscular block.
Methods:Sixty-six patients undergoing laparoscopic inguinal hernia repair were randomised to receive a neuromuscular block (train-of-four 1e2 twitches) using rocuronium or no neuromuscular block with the P-LMA. All operations were performed by the same surgeon who determined the surgical conditions using the Leiden-surgical rating scale (L-SRS).Secondary outcomes included perioperative data, haemodynamics, and adverse events.
Results:Neuromuscular block improved surgical conditions compared with no neuromuscular block: mean (standard deviation) L-SRS 4.1 (0.5) vs 3.5 (0.6), respectively (P<0.0001). Mean rocuronium dose in the neuromuscular block group was 12.7 (4.4-29.7) mg or 0.7 (0.6-0.8) mg kg-1. The insufflation Ppeak was higher in the no neuromuscular block group than in the neuromuscular block group: mean (standard deviation) Ppeak 17.9 (1.8) cm H2O vs 16.2 (1.9) cm H2O, respectively (P=0.0004). Fifteen children (45.5%) in the no neuromuscular block group had adverse events during the surgery and anaesthesia vs four children (12.1%) in the neuromuscular block group (P=0.006).
Conclusion:Neuromuscular block significantly improved surgical conditions and reduced the incidence of adverse events during surgery and anaesthesia when an LMA Proseal™ was used in short-duration paediatric laparoscopic surgery.