中国癌症杂志 ›› 2019, Vol. 29 ›› Issue (3): 212-217.doi: 10.19401/j.cnki.1007-3639.2019.03.009

• 论著 • 上一篇    下一篇

舒更葡糖钠在甲状腺癌根治术神经监测中的应用

刘 溪1,孙志荣1,杨舒雯2,顾悦超1,缪长虹1,王 宇2   

  1. 1. 复旦大学附属肿瘤医院麻醉科,复旦大学上海医学院肿瘤学系,上海 200032 ;
    2. 复旦大学附属肿瘤医院头颈外科,复旦大学上海医学院肿瘤学系,上海 200032
  • 出版日期:2019-03-30 发布日期:2019-04-26
  • 通信作者: 王 宇 E-mail: neck130@hotmail.com
  • 基金资助:
    上海市“科技创新行动计划”产学研医(16DZ1930304);上海市科委科技支撑项目子课题(16DZ1911107)。

Application of sugammadex in the electrophysiology of thyroid surgery

LIU Xi1, SUN Zhirong1, YANG Shuwen2, GU Yuechao1, MIAO Changhong1, WANG Yu2   

  1. 1.Department of Anesthesia,Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; 2. Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
  • Published:2019-03-30 Online:2019-04-26
  • Contact: WANG Yu E-mail: neck130@hotmail.com

摘要: 背景与目的:肌松药的使用可能影响甲状腺癌根治术神经监测的电信号检出率,该研究旨在探讨舒更葡糖钠(sugammadex)术中逆转罗库溴铵的肌松作用,评估其优化甲状腺癌根治术神经监测的效果。方法:75例拟行择期甲状腺癌根治术的患者,年龄18~75岁,随机分为A组:诱导时罗库溴铵0.6 mg/kg,术中舒更葡糖钠2.0 mg/kg拮抗,B组:诱导时罗库溴铵0.3mg/kg,术中加0.9%NaCl溶液拮抗,分别记录两组气管插管时间,术中体动次数,迷走神经和喉返神经电信号基础值、拮抗后1、2、3、5 min和甲状腺病灶切除后的神经监测值,以及术后声音嘶哑等并发症。结果:与A组相比,B组插管时间[(193±73)min]较A组[(113±66)min]显著延长(P=0.00),术中体动次数显著增多(P=0.022);A组,舒更葡糖钠拮抗后喉返神经及迷走神经监测值均较基础值显著升高(P=0.026,P=0.032);术后并发症两组间无显著差异。结论: 麻醉诱导采用0.6 mg/kg罗库溴铵,术中舒更葡糖钠逆转肌松作用,可同时确保麻醉诱导安全和甲状腺癌根治术喉返神经监测的有效性。

关键词: 舒更葡糖钠, 喉返神经监护, 甲状腺癌根治术, 罗库溴铵

Abstract: Background and purpose: Neuromuscular blocking agent may affect the application of nerve monitoring during thyroidectomy. Therefore this study aimed at evaluating the effect of sugammadex on rocuronium bromide in nerve monitoring during thyroidectomy. Methods: A total of 75 patients undergoing elective radical thyroidectomy were randomly divided into two groups: A, induction with rocuronium bromide 0.6 mg/kg and reversal with sugammadex during the operation; B, induction with rocuronium bromide 0.3 mg/kg and reversal with physiological saline during the operation. Tracheal intubation time, counts of the intraoperative body movements, postoperative complications and the monitoring values of recurrent laryngeal nerve and vagus nerve were recorded. Results: The intubation time of A group [(193±73) min]was significantly longer than that of the B group [(113±66) min](P=0.000), and the B group also had more intraoperative body movements (P=0.022). After sugammadex treatment, the values of recurrent laryngeal nerve and vagus nerve were significantly higher than the basal value in the A group (P=0.026, P=0.032). There was no significant difference in postoperative complications between the two groups. Conclusion: Induction with 0.6 mg/kg rocuronium bromide and reversal with sugammadex in the operation can make sure of the safety in anesthesia induction and the effectiveness of recurrent laryngeal nerve monitoring during thyroid surgery.

Key words: Sugammadex, Intraoperative neuromonitoring, Thyroidectomy, Rocuronium