本文概述了传统日间腹腔镜胆囊切除术患者术后早期康复质量存在的问题,IMB模型通过向患者提供科学的疾病知识,改变其疾病认知与态度,最终促使其采纳并维持健康行为。本文还介绍了IMB模型在日间腹腔镜胆囊切除术后患者早期康复质量中应用涉及的相关概念、研究背景和国内外的研究现状以及未来发展趋势与挑战。研究结果显示,IMB模型可显著降低患者术后疼痛发生率,并提高患者参与治疗决策的程度,为后期关于IMB模型在日间腹腔镜胆囊切除术患者术后早期康复质量的相关研究提供借鉴与参考,以便后期实施相关个性化干预措施,并提供相关理论依据。
This paper summarizes the problems existing in the early postoperative rehabilitation quality of patients undergoing traditional ambulatory laparoscopic cholecystectomy.The IMB model changes patients’ disease cognition and attitude by providing them with scientific disease knowledge,and ultimately promotes their adoption and maintenance of healthy behaviors.It also introduces the relevant concepts involved in the application of the IMB model in the early postoperative rehabilitation quality of patients undergoing ambulatory laparoscopic cholecystectomy,the research background of this study,the current research status at home and abroad,as well as the future development trends and challenges.The research results show that the IMB model can significantly reduce the incidence of postoperative severe pain in patients and the degree of patient participation in treatment decision-making.This provides reference and guidance for subsequent studies on the early rehabilitation quality of patients undergoing ambulatory laparoscopic cholecystectomy using the IMB model,so as to implement relevant personalized intervention measures in the future and provide relevant theoretical basis.
目的 探讨术前静注艾司氯胺酮在腹腔镜结直肠癌根治术患者中的应用效果。方法 前瞻性分析2024年1月—2025年4月在厦门市中医院行腹腔镜结直肠癌根治术患者的临床资料,根据随机数字表法将患者分为两组:对照组40例,术前5 min予5 mL生理盐水;观察组40例,术前5 min予以0.25 mg/kg艾司氯胺酮(以生理盐水配置成5 mL)。比较围术期指标、炎症因子、负性情绪、疼痛情况、不良反应。结果 观察组的手术时间、麻醉时间、术中出血量分别为(213.54±64.22)min、(240.67±81.26)min、(141.31±45.03)mL,与对照组的(210.43±65.71)min、(244.25±81.33)min、(137.64±42.75)mL比较,差异均无统计学意义(t=0.214、0.197、0.374,P均>0.05),而观察组丙泊酚、瑞芬太尼用量分别为(1 075.52±134.37)mg、(1 267.18±242.26)μg,虽然低于对照组的(1?126.64±150.21)mg、(1 352.50±295.14)μg,但差异也无统计学意义(t=1.604、1.413,P均>0.05);观察组在术后24 h的肿瘤坏死因子-α、白介素-6、C反应蛋白水平分别为(54.52±9.64)pg/mL、(40.08±7.75)pg/mL、(30.38±6.93)mg/L,均低于对照组的(77.31±10.86)pg/mL、(56.35±9.47)pg/mL、(43.73±7.61)mg/L(t=9.926、8.409、8.203,P均<0.05);术后1 d的焦虑、抑郁自评量表评分及术后1 h、6 h、12 h、24 h咳嗽时的疼痛视觉模拟量表评分分别为(51.92±4.41)分、(53.96±4.47)分、(3.59±1.14)分、(3.06±1.01)分、(2.89±0.91)分、(2.57±0.76)分,均低于对照组的(55.06±5.12)分、(57.21±5.19)分、(4.27±1.36)分、(3.68±1.18)分、(3.41±1.06)分、(2.96±0.92)分(t=2.939、3.001、2.423、2.525、2.329、2.067,P均<0.05),但两组术后48 h咳嗽时疼痛视觉模拟量表评分比较差异无统计学意义(P>0.05);两组术后不良反应发生率也无显著差异(P<0.05)。结论 在腹腔镜结直肠癌根治术术前静注艾司氯胺酮可有效降低术后炎症反应水平,减轻术后疼痛,缓解术后负性情绪,且不会增加患者术后不良反应发生率。
Objective To explore the application effect of preoperative intravenous injection of esketamine in patients undergoing laproscopic radical resection of colorectal cancer.Methods The clinical data of patient who underwent laparoscopic radical resection of colorectal cancer in Xiamen Hospital of Traditional Chinese Medicine from January 2024 to April 2025 were retrospectively analyzed.The patients were divided into two groups according to the random number table method:40 cases in the control group were given 5 mL saline,five minutes before operation,40 cases in the observation group were treated with 0.25 mg / kg esketamine(in 5 mL saline)five minutes before operation.The perioperative indicators,inflammatory factors,negative emotions,pain and adverse reactions were compared between two groups.Results The operation time,anesthesia time and intraoperative blood loss of the observation group were(213.54±64.22)min,(240.67±81.26)min and(141.31±45.03)mL,respectively,which were not significantly different from those of the control group(210.43±65.71)min,(244.25±81.33)min and(137.64±42.75)mL(t=0.214,0.197,0.374,all P>0.05).The dosage of propofol and remifentanil in the observation group were(1 075.52±134.37)mg and(1 267.18±242.26)μg,respectively,which were lower than those in the control group of (1126.64±150.21)mg and(1352.50±295.14)μg,but the difference was not statistically significant(t=1.604,1.413,P>0.05).The levels of tumor necrosis factor-α,interleukin-6 and C-reactive protein in the observation group at 24 h after operation were(54.52±9.64)pg / mL,(40.08±7.75)pg / mL and(30.38±6.93)mg / L,respectively,which were lower than those in the control group of (77.31±10.86)pg / ml,(56.35±9.47)pg / mL and 43.73±7.61)mg / L(t=9.926,8.409,8.203,all P<0.05).The scores of Anxiety and Depression Self-Rating Scale at 1 day after operation and the scores of pain visual analogue scale at 1 h,6 h,12 h and 24 h after operation were(51.92±4.41),(53.96±4.47),(3.59±1.14),(3.06±1.01),(2.89±0.91) and(2.57±0.76),respectively,which were lower than those of the control group(55.06±5.12),(57.21±5.19),(4.27±1.36),(3.68±1.18),(3.41±1.06) and(2.96±0.92)(t=2.939,3.001,2.423,2.525,2.329,2.067,P<0.05).However,no significant difference was observed in cough-related VAS scores between the groups at 48 h postoperatively(P>0.05).Adverse event rates showed no significance in two groups(P>0.05).Conclusions Preoperative administration of esketamine in laparoscopic colorectal cancer surgery can attenuate postoperative inflammation,decrease pain,mitigate negative emotions,without increasing the incidence of postoperative adverse reactions.
目的:探讨免气腹、免全身麻醉腹腔镜辅助下腹股沟疝无张力修补术对患者术中生命体征稳定性及术后恢复的影响。方法:选取广州市从化区中医医院及花都区人民医院于2023年7月至2025年6月收治的腹股沟疝患者,按照手术方式的不同分为研究组与对照组。对照组行传统气腹全身麻醉腹腔镜下腹股沟疝无张力修补术(TEP 或 TAPP 术式),研究组行免气腹、免全身麻醉腹腔镜辅助下腹股沟疝无张力修补术。比较两组患者术中呼吸、循环功能变化,术后并发症发生情况,以及术后肛门排气时间、住院时间和住院费用。结果:两组患者一般资料比较,差异无统计学意义。研究组术中血压波动幅度小于对照组(P<0.05),心率及血氧饱和度变化与对照组比较差异无统计学意义。亚组分析显示,研究组中采用 TAPP 术式的患者呼吸波动大于对照组中采用 TAPP 术式的患者(P<0.05),而两组中采用 TEP 术式的患者呼吸波动差异无统计学意义(P>0.05)。研究组手术时间短于对照组,术中出血量高于对照组(P<0.05)。两组住院时间比较差异无统计学意义(P>0.05),但研究组术后肛门排气时间更短、总住院费用更低(P<0.05)。结论:免气腹、免全身麻醉腹腔镜辅助下腹股沟疝无张力修补术有助于缩短手术时间,促进术后胃肠功能恢复,并降低住院费用,具有一定的临床应用价值。
目的 探讨超声引导下腹横肌平面阻滞(TAP)联合无阿片药全身麻醉(全麻)在腹腔镜子宫全切术中的应用效果。方法 选取武威市凉州医院2021年5月—2023年5月收治的60例择期行腹腔镜子宫全切术患者展开前瞻性研究,应用抽签法将其分为观察组与对照组,各30例。对照组患者实施常规阿片类药物全麻,观察组采用TAP联合无阿片药全身麻醉。对比两组患者入室后(T0)、切皮时(T1)、手术10 min后(T2)和手术结束即刻(T3)生命体征变化,麻醉后监测治疗室(PACU)恢复情况,术后1、4、8、12、24、48 h疼痛程度,最后对比其48 h内不良反应发生率。结果 两组T0、T1、T2、T3时间血氧饱和度(SpO2),T0、T3时间平均动脉压(MAP)、心率水平无明显变化,两组对比差异无统计学意义(P>0.05),T1、T2时间对照组MAP、心率升高,观察组T1、T2的MAP、心率均低于对照组(P<0.05);观察组PACU停留时间、首次肛门排气时间明显低于对照组(P<0.05);观察组术后1、4、8、12、24、48 h活动时视觉模量表(VAS)评分与静息时VAS评分低于对照组(P<0.05);观察组术后48 h内不良反应发生率比对照组更低(P<0.05)。结论 针对腹腔镜子宫全切术患者采取超声引下TAP联合无阿片药全麻可稳定患者术中生命体征,缩短患者术后恢复时间,减轻疼痛程度,且可降低术后48 h内不良反应发生率。
Objective To explore the application effect of ultrasound-guided transverse abdominis plane(TAP)block combined with opioid-free general anesthesia in laparoscopic total hysterectomy.Methods A prospective study was conducted in 60 patients who underwent selective laparoscopic total hysterectomy in Wuwei Liangzhou Hospital from May 2021 to May 2023.They were divided into a observation group and a control group using a lottery method,30 cases in each group.The control group received routine opioid general anaesthesia,while the observation group received TAP in combination with opioid-free general anaesthesia.Comparing the changes of vital signs after invasion(T0),skin cutting(T1),10 min after operating(T2),the end of surgery(T3),and condition in the post-anesthesia care unit(PACU)after anesthesia,the pain degree at 1 h,4 h,8 h,12 h,24 h and 48 h after surgery,and the incidence of adverse reactions within 48 h.Results There were no significant changes in blood SpO2,mean arterial pressure(MAP)and heart rate at T0,T1,T2 and T3 in both groups,and no significant difference between the two groups(P>0.05).MAP and heart rate increased in the control group at T1 and T2,while those in the observation group were lower than the control group(P<0.05).The observation group had significantly shorter PACU time and first anal exhaust time than the control group(P<0.05).VAS scores at 1 h,4 h,8 h,12 h,24 h and 48 h after surgery and VAS score at rest in the observation group were lower than in the control group(P<0.05).The incidence of adverse reactions within 48 h after surgery was lower in the observation group than in the control group(P<0.05).Conclusions Ultrasound guided TAP combined with opioid-free general anesthesia can stabilize intraoperative vital signs,shorten postoperative recovery time,alleviate postoperative pain,and reduce the incidence of anesthesia related adverse reactions within 48 hours for patients undergoing laparoscopic total hysterectomy.
腹腔镜手术后除躯体创伤疼痛,部分患者还可能经历痛苦的术后内脏痛,不仅使患者术后体验不佳,疼痛应激甚至可能加重机体的内环境紊乱,不利于患者的术后康复。内脏痛是来源于内脏器官和组织的疼痛,其产生与脏器的平滑肌痉挛、扩张、缺血、化学炎症刺激等密切相关。在这个过程中,许多离子通道和受体在调节内脏伤害性刺激信号的传导上发挥作用。目前,临床上术后镇痛治疗方案多样,但如何针对性地控制术后内脏痛是临床医生需要面对和解决的问题。为此,该文对腹腔镜术后内脏痛发生的相关机制、内脏感觉的神经传导及临床特征、治疗进展进行综述。
In addition to physical trauma,patients undergoing laparoscopic surgery may also experience postoperative visceral pain.This pain not only impacts the patient's postoperative experience,but can also worsen the body's internal environment and hinder recovery.Visceral pain originates from internal organs and tissues.It is closely related to smooth muscle spasms,dilations,ischemia,and chemical inflammatory stimulation of organs.In this process,numerous ion channels and receptors regulate the transmission of visceral nociceptive stimulus signals.At present,there are multiple clinical treatment options available for postoperative pain management.However,clinicians must overcome the challenge of controlling postoperative visceral pain.This article provides a review of the relevant mechanisms of visceral pain following laparoscopic surgery,the neural conduction of visceral sensation,clinical characteristics and treatment advancements.
目的 观察低浓度布比卡因联合全身麻醉在腹腔镜下直肠癌根治术中的应用及对患者体征及苏醒质量的影响。方法 选择2020年1月—2021年6月在信阳一五四医院实施腹腔镜镜下直肠癌根治术治疗的126例直肠癌患者为研究对象,通过抽签法对患者进行分组,将其中63例列为全麻组,术中单纯实施全身麻醉,其余63例列为联合组,术中采用低浓度布比卡因联合全身麻醉,比较两组患者体征变化情况,苏醒质量,麻醉相关不良反应,并开展为期1.5年的随访,评估两组患者远期生存质量。结果 联合组术中、术后的心率、平均动脉压均低于全麻组(P<0.05);术后,联合组的Steward麻醉苏醒评分略低于全麻组、麻醉恢复室停留时间略高于全麻组(P>0.05);但联合组的视觉模拟疼痛评分、镇静评分均低于全麻组(P<0.05);联合组的麻醉相关不良反应发生率略高于全麻组(P>0.05);随访期间,联合组的肠癌患者生存质量测定量表各维度评分均高于全麻组(P<0.05)。结论 低浓度布比卡因联合全身麻醉的麻醉效果更加平稳、安全性高。
Objective To observe the application of low concentration bupivacaine combined with general anesthesia in laparoscopic radical resection of rectal cancer and its effect on the physical signs and recovery quality of patients. Methods In this study,126 rectal cancer patients who underwent laparoscopic radical resection of rectal cancer in Xinyang 154th Hospital from January 2020 to June 2021 were selected as the research subjects.The patients were divided into groups by drawing lots.Among them,63 patients were included in general anesthesia group,and the rest 63 patients were included in combined group.Low-concentration bupivacaine combined with general anesthesia was used in combined group during the operation.The changes of physical signs and the quality of recovery were compared between the two groups.Anesthesia related adverse events,and the long-term quality of life of the two groups of patients was evaluated through one-year and a half follow-up. Results The heart rate and mean arterial pressure during and after surgery in the combined group were lower than those in the general anesthesia group(P<0.05).After surgery,the Steward anesthesia recovery score of the combined group was slightly lower than that of the general anesthesia group,and the PACU stay time was slightly higher than that of the general anesthesia group(P>0.05).However,the VAS score and Richmond Agitation-Se dation Scale score of the combined group were lower than those of the general anesthesia group(P<0.05).The incidence of anesthesia related adverse reactions in the combination group was slightly higher than that in the general anesthesia group(P>0.05).During the follow-up period,the FACT-C scores of all dimensions in the combination group were higher than those in the general anesthesia group(P<0.05). Conclusions The anesthesia effect of low concentration bupivacaine combined with general anesthesia is significant and safe.
目的 探讨快速康复理念联合腹腔镜手术治疗对小儿腹股沟疝疗效观察。方法 选取焦作市妇幼保健院2021年1月—2023年1月收治的86例腹股沟疝患儿进行分析与研究,应用随机数字表法将其分为观察组与对照组,各组均为43例。所有患儿均采取腹腔镜手术治疗,对照组采取常规护理,观察组采取快速康复理念护理。对比两组围术期恢复情况,术后4、12、24、48 h疼痛程度,并发症及护理满意度情况。结果 观察组首次下床时间、首次肛门排气时间、进食时间、住院时间短于对照组(P<0.05);两组患儿术后4、12、24、48 h视觉模拟量表(VAS)评分逐渐降低,观察组低于对照组(P<0.05);两组恶心呕吐、尿潴留、腹胀腹痛、感染并发症发生率对比差异无统计学意义(P>0.05);观察组患儿及家长健康教育、住院环境、专科护理、检查指导、病情观察相关护理满意度评分高于对照组(P<0.05)。结论 快速康复理念联合腹腔镜手术治疗小儿腹股沟疝效果显著,可进一步促进患儿早日康复,缩短住院时间,术后疼痛水平低,同时可提升患儿及家长护理满意度。
Objective To explore the therapeutic effect of rapid rehabilitation concept combined with laparoscopic surgery on pediatric inguinal hernia.Methods A total of 86 children with inguinal hernia admitted to Jiaozuo Maternal and Child Health Care Hospital from January 2021 to January 2023 were selected for analysis and study,and divided into observation group and control group by random number table method,with 43 cases in each group.All patients were treated with laparoscopic surgery,while the control group received routine care,while the observation group received rapid recovery concept care.The perioperative recovery,pain level,complications,and nursing satisfaction at 4,12,24,and 48 hours after surgery were compared.Results The first discharge time,first anal exhaust time,feeding time,and hospitalization time were shorter than the control group(P<0.05).The VAS scores decreased after 4 h,12 h,24 h and 48 h,and the observation group was lower than the control group(P<0.05).The incidences of nausea and vomiting,urinary retention,abdominal distension,abdominal pain and infectious complications between the two groups were significantly insignificant(P>0.05).The health education,inpatient environment,specialized care,nursing examination guidance and condition observation were significantly higher than that of the observation group(P<0.05).Conclusions The combination of rapid recovery concept and laparoscopic surgery for the treatment of inguinal hernia in children has a significant effect,which can further promote early recovery,shorten hospital stay,lower postoperative pain levels.At the same time,it can improve the nursing satisfaction of children and parents.
目的 探讨成人全身麻醉(全麻)腹腔镜下腹股沟疝修补日间手术的可行性及安全性。方法 回顾性分析2021年1月—2023年12月广州市第一人民医院收治的进行全麻腹腔镜下疝修补手术治疗的成人患者病历资料,根据患者住院手术模式分为日间手术组、传统手术组。日间手术组采用日间手术模式下全麻腹腔镜腹股沟疝修补术,传统手术组采用传统入院模式下择期全麻腹腔镜下腹股沟疝修补术,对比分析两组可行性(住院时间、住院费用、患者满意度)、安全性(手术时间、手术的出血量、手术并发症的发生率)等。结果 最终纳入199例病例,日间手术组52例(26.1%),传统手术组147例(73.9%)。与传统手术组相比较,日间手术组住院时间、术前住院时间、术后住院时间缩短,满意度评分升高,差异具有统计学意义(P<0.05)。在手术费用、住院总费用、术后24 h疼痛评分、手术时间、手术的出血量、手术并发症的发生率方面,组间比较差异均无统计学意义(P>0.05)。结论 成人全麻腹腔镜下腹股沟疝修补日间手术,能够缩短患者的住院时间,提高患者的住院满意程度,不增加手术风险和并发症发生率,是安全、有效的。
Objective To explore and analyze the feasibility and safety of laparoscopic inguinal hernia repair surgery under general anesthesia in adults.Methods A retrospective analysis was conducted on the medical records of patients admitted to a hospital from January 2021 to December 2023 who underwent laparoscopic hernia repair surgery under general anesthesia.The patients were divided into day surgery group and traditional surgery group based on their hospitalization surgery mode.The daytime surgery group underwent laparoscopic inguinal hernia repair under general anesthesia in the daytime surgery mode,while the traditional surgery group underwent elective laparoscopic inguinal hernia repair under general anesthesia in the traditional admission mode.The feasibility(hospitalization duration,hospitalization cost,patient satisfaction)and safety(surgery duration,surgical bleeding volume,incidence of surgical complications)of the two groups were compared and analyzed.Results A total of 199 cases were enrolled,with 52 cases(26.1%)in the day surgery group and 147 cases(73.9%)in the traditional surgery group.Compared with the traditional surgery group,the daytime surgery group showed a decrease in length of hospital stay,preoperative hospital stay,and postoperative hospital stay,while the satisfaction score increased,and the difference was statistically significant(P<0.05).There was no difference(P>0.05)between the two groups in terms of surgical costs,total hospitalization costs,postoperative 24-hour pain scores,surgical time,surgical bleeding volume,and incidence of surgical complications.Conclusion sLaparoscopic inguinal hernia repair under general anesthesia during the day for adults is safe and effective.
目的 探究单孔腹腔镜胆囊切除术(LC)治疗胆囊结石(GD)患者的效果。方法 回顾性收集2021年1月—2023年9月郑州大学附属郑州中心医院收治的96例GD患者病例资料,按手术方案不同分两组。以接受单孔LC治疗的48例患者列为A组,以接受三孔LC治疗的48例患者列为B组。对比两组围术期指标、手术前后胃肠激素指标[胃泌素(GAS)、胃动素(MTL)]、肝功能指标[天门冬氨酸转氨酶(AST)、丙氨酸氨基转移酶(ALT)]、疼痛介质指标[前列腺素E2(PGE-2)、5-羟色胺(5-HT)]水平、术后并发症发生率。结果 A组手术用时(71.56±6.29)min更长于B组(62.37±5.85)min,术后排气时间(15.37±2.26)h、住院用时(5.30±1.24)d、切口总长度(1.84±0.27)cm短于B组(17.49±3.55)h、(7.64±1.35)d、(4.13±0.35)cm,术中失血量(41.28±4.36)mL低于B组(58.31±6.52)mL更低(均P<0.001);术后1 d A组GAS(113.34±13.47)pg/mL、MTL(202.78±24.68)pg/mL水平高于B组(102.65±11.08)pg/mL、(164.34±20.76)pg/mL(均P<0.001);术后1d A组AST(31.82±3.62)U/L、ALT(40.36±4.74)U/L水平低于B组(38.78±4.03)U/L、(51.60±5.42)U/L(均P<0.001);术后1 d A组SP(55.84±5.90)ng/L、5-HT(132.17±9.16)ng/mL、PGE-2(25.45±4.27)ng/mL水平低于B组(73.27±7.51)ng/L、(173.54±13.32)ng/mL、(31.71±5.24)ng/mL(均P<0.001);A组并发症发生率2.08%(1/48)低于B组16.67%(8/48)更低。结论 与三孔LC治疗GD患者相比,经单孔LC治疗会略微延长手术用时,但能进一步减少术中失血量,降低术后并发症风险,缩短切口长度及患者康复进程,且对机体胃肠功能、肝功能影响更小,对机体造成疼痛应激更轻微,更符合微创特征。
Objective To explore the effect of single-incision laparoscopic cholecystectomy(LC)in the treatment of patients with gallstone disease(GD).Methods Retrospective data of 96 GD patients in Zhengzhou Central Hospital Affiliated to Zhengzhou University(January 2021—September 2023)were collected and divided into two groups according to different surgical protocols.Forty-eight patients receiving single-incision LC were classified as group A,and 48 patients receiving three-port LC were classified as group B.The perioperative indexes,gastrointestinal hormone indexes[gastrin(GAS),motilin(MTL)],liver function indexes[aspartate aminotransferase(AST),alanine aminotransferase(ALT)],pain mediator indexes[prostaglandin E2(PGE-2),5-hydroxytryptamine(5-HT)] before and after operation,and the incidence of postoperative complications were compared between the two groups.Results The operation time in group A was(71.56±6.29)min,which was longer than that in group B(62.37±5.85)min.In group A,the postoperative exhaust time was(15.37±2.26)h,hospitalization time was(5.30±1.24)d,and the total length of incision was(1.84±0.27)cm,which were shorter than those in group B[(17.49±3.55)h,(7.64±1.35)d,and(4.13±0.35)cm].The intraoperative blood loss was(41.28±4.36)mL,which were lower than(58.31±6.52)mL in group B(all P<0.001).The levels of GAS[(113.34±13.47)pg/mL] and MTL[(202.78±24.68)pg/mL] in group A were higher than those in group B[(102.65±11.08)pg/mL and(164.34±20.76)pg/mL](all P<0.001).The levels of AST[(31.82±3.62)U/L] and ALT[(40.36±4.74)U/L] in group A were lower than those in group B[(38.78±4.03)U/L and(51.60±5.42)U/L](all P<0.001).The levels of SP[(55.84±5.90)ng/L],5-HT[(132.17±9.16)ng/mL],pge-2[(25.45±4.27)ng/mL] in group A were lower than those in group B[(73.27±7.51)ng/L,(173.54±13.32)ng/mL and (31.71±5.24)ng/mL](all P<0.001).The incidence of complications in group A was 2.08%(1/48),which was lower than that in group B[16.67%(8/48)](χ2=4.414,P=0.036).Conclusion sCompared with three-port LC for GD patients,single-incision LC can slightly prolong the operation time,but it can further reduce the intraoperative blood loss,reduce the risk of postoperative complications,shorten the incision length and the rehabilitation process of patients,and has less impact on the gastrointestinal function and liver function,causing less pain stress to the body,which is more in line with the characteristics of minimally invasive.
目的 探究新斯的明拮抗顺阿曲库铵的时机对患者腹腔镜结直肠癌根治术后肌松残留和早期肺功能的影响。方法 选取于2021年2月—2022年9月在我院行结肠癌根治手术的194例患者为研究对象,以随机数字表法将患者分为空白对照组和试验组,然后结合给予新斯的明治疗时所体现的4个成串刺激(TOF)比值将试验组患者分为试验组A(TOF≤0.1)、试验组B(0.10.8)。对比组间肌松残余情况以及肺功能情况。结果 插管前,试验组A患者TOF比值低于其他组(P<0.01),空白对照组患者TOF比值高于其他组(P<0.01);空白对照组分别与试验组A~E在复苏室接受观察的时间比较,差异无统计学意义(P>0.01);试验组A患者肌松恢复指数低于其他组(P<0.01),空白对照组患者肌松恢复指数高于其他组(P<0.01)。插管前、拔管0.5 h以及拔管24 h时,组间1秒用力呼气容积(FEV1)、用力肺活量(FVC)和FEV1/FVC比较差异无统计学意义(P>0.05)。结论 结直肠癌根治术后给予新斯的明,有助于加快肌松恢复,但不会影响复苏室停留时间与肺功能水平。
Objective To investigate the effect of timing of neostigmine antagonizing cisatracurium on residual muscle relaxation and early lung function in patients underwent laparoscopic radical resection of colorectal cancer.Methods February 2021 to September 2022,194 patients who underwent radical colon cancer surgery in our hospital were selected as the research subjects.The patients were randomly divided into a blank control group and an experimental group using a random number table method.Then,combined with the train-of-four(TOF)ratios observed during neostigmine treatment,the experimental group patients were divided into experimental group A(TOF≤0.1),experimental group B(0.10.8).The residual muscle relaxation and lung function between groups were compared.Results Before intubation,the TOF ratio of patients in experimental group A was lower than that of other groups(P<0.01),while the TOF ratio of patients in the blank control group was higher than that of other groups(P<0.01).There was no significant difference in the observation time between the blank control group and the experimental group A~E in the postanesthesia care unit(P>0.01).The muscle relaxation recovery index of patients in experimental group A was lower than that of other groups(P<0.01),while the muscle relaxation recovery index of patients in the blank control group was higher than that of other groups(P<0.01).There were no significant differences in force expiratory volume in one second(FEV1),forced Vital capacity(FVC)and FEV1/FVC between groups before intubation,0.5 h after extubation and 24 h after extubation(P>0.05).Conclusions Administration of neostigmine after radical surgery for colorectal cancer can accelerate muscle relaxation recovery,but it will not affect the residence time of the postanesthesia care unit and lung function levels.