深度神经肌肉阻滞对老年结肠癌患者腹腔镜手术后肠道屏障功能及心肺功能的作用研究

Effect of deep neuromuscular blockade on intestinal barrier function and cardiopulmonary function after laparoscopic surgery in the elderly

摘要:

目的 探讨深度神经肌肉阻滞对老年结肠癌患者腹腔镜手术后肠道屏障功能及心肺功能的作用。方法 选取2019年1月—2021年12月在江南大学附属医院行腹腔镜手术的92例老年结直肠癌患者，并随机分为研究组和对照组，各46例。研究组采用深度神经肌肉阻滞，对照组采用中度神经肌肉阻滞。比较两组患者血浆D-乳酸、血浆二胺氧化酶（DAO）、C反应蛋白（CRP）、心率、平均动脉压、动态肺顺应性、氧合指数、手术时间、手术条件评分、术中气腹压、术后拔管时间、术后苏醒时间、术后住院时间、胃肠道排气时间及术后肺部并发症。结果 研究组与对照组术前（T₁）及术后即刻（T₂）、24 h（T₃）、48 h（T₄）的血浆D-乳酸、DAO、CRP、心率、平均动脉压、动态肺顺应性、氧合指数比较，采用重复测量设计的方差分析，结果 ①不同时间点血浆D-乳酸、DAO、CRP、心率、平均动脉压、动态肺顺应性、氧合指数有差异（F =316.49、122.38、251.03、22.183、34.286、67.203和12.052，均P =0.000）；②研究组与对照组血浆D-乳酸、DAO、CRP、心率、平均动脉压、动态肺顺应性、氧合指数有差异（F =8.759、6.416、11.620、5.212、4.594、4.006和4.214，均P =0.000），研究组较对照组血浆D-乳酸、DAO、CRP水平低，心率、平均动脉压、动态肺顺应性、氧合指数高，镇痛效果相对较好；③两组血浆D-乳酸、DAO、CRP、心率、平均动脉压、动态肺顺应性、氧合指数变化趋势有差异（F =16.767、9.731、19.937、6.018、5.972、8.141和6.495，均P =0.000）。两组手术时间、术后住院时间比较，差异均无统计学意义（P >0.05）。研究组手术条件评分高于对照组（P <0.05），术中气腹压低于对照组（P <0.05），术后拔管时间、术后苏醒时间、胃肠道排气时间均短于对照组（P <0.05）。研究组肺部并发症总发生率低于对照组（P <0.05）。结论 深度神经肌肉阻滞用于老年结肠癌患者腹腔镜手术能够改善肠道屏障功能和心肺功能，促进患者术后恢复，降低肺部并发症发生率。

Abstract:

Objective To explore the effect of deep neuromuscular blockade on intestinal barrier function and cardiopulmonary function after laparoscopic surgery in the elderly.Methods A total of 92 elderly patients with colorectal cancer who were admitted to the Affiliated Hospital of Jiangnan University for laparoscopic surgery from January 2019 to December 2021 were selected and randomly divided into study group and control group, with 46 cases in each group. The study group was given deep neuromuscular blockade, and the control group was given moderate neuromuscular blockade. The levels of plasma D-lactate, plasma diamine oxidase (DAO), and C-reactive protein (CRP), heart rate, mean arterial pressure, dynamic lung compliance, oxygenation index, operative duration, operative condition score, intraoperative pneumoperitoneum pressure, time to postoperative extubation, time to postoperative recovery, length of postoperative hospital stay, time to pass flatus, and postoperative pulmonary complications were compared between the two groups.Results The levels of plasma D-lactate, DAO and CRP, heart rate, mean arterial pressure, dynamic lung compliance, and oxygenation index before the operation (T₁), immediately after the operation (T₂), 24 h after the operation (T₃), and 48 h after the operation (T₄) in the two groups were compared via repeated measures analysis of variance, and the results revealed that they were different among the time points (F = 316.49, 122.38, 251.03, 22.183, 34.286, 67.203 and 12.052, all P = 0.000) and between the two groups (F = 8.759, 6.416, 11.620, 5.212, 4.594, 4.006 and 4.214, all P = 0.000). Specifically, the levels of plasma D-lactate, DAO and CRP were lower, and heart rate, mean arterial pressure, dynamic lung compliance, and oxygenation index were higher in the study group compared with those in the control group, indicating relatively better analgetic effects. Besides, the change trends of these indicators were also different between the two groups (F = 16.767, 9.731, 19.937, 6.018, 5.972, 8.141 and 6.495, all P = 0.000). There was no significant difference in the operative duration and length of postoperative hospital stay between the two groups (P > 0.05). The operative condition score in the study group was higher than that in the control group (P < 0.05). The intraoperative pneumoperitoneum pressure was lower, and time to postoperative extubation, time to postoperative recovery and time to pass flatus were shorter in the study group than those in the control group (P < 0.05). The overall incidence of pulmonary complications in the study group was lower than that in the control group (P < 0.05).Conclusions As for elderly patients undergoing laparoscopic surgery, deep neuromuscular blockade may improve intestinal barrier function and cardiopulmonary function, promote postoperative recovery, and reduce the incidence of pulmonary complications.