腹腔镜肝切除术中不同肌松程度对 肝脏灌注和肝功能的影响.

Objective To investigate deep neuromuscular blockade(NMD) and moderate NMD on hepatic perfusion and liver function during laparoscopic hepatectomy. Methods A total of 60 patients who received laparoscopic hepatectomy in Fudan University Shanghai Cancer Center were recruited from Dec 2021 to Dec 2022. They were randomly divided into two groups： deep NMD group(D group, n=30) and moderate NMD group(M group, n=30). D group was induced by administration of rocuronium 0.9 mg/kg followed by continuous infusion to maintain intraoperative post-tetanic count(PTC) of 1-2, while M group was induced by administration of rocuronium 0.6 mg/kg followed by continuous infusion to maintain intraoperative train-of-four(TOF) of 1-2. Indocyanine green(ICG) of 0.25 mg/kg was given intravenously both after induction and after specimen excision, and retention rate at fifteen minutes(ICGR15) was recorded. In addition, intraoperative rocuronium dosage, surgical operation satisfaction score, postoperative shoulder pain, and the occurrence of vomiting on postoperative day 1（POD1) were also recorded. Results Compared with M group, the dosage of rocuronium in D group was significantly increased(P<0.01), but there was no difference of ICGR15 between the two groups(P=0.581), even other parameters of perioperative liver function. The surgical operation satisfaction score was significantly higher(P<0.05), while the postoperative shoulder pain(P=0.037, OR=1.37, 95%CI：1.01-1.86) and the occurrence of vomiting on POD1（P=0.017, OR=1.64, 95%CI：1.07-2.53) were significantly lower in D group than those in M group. Conclusion Compared with moderate NMB, deep NMB can significantly improve surgery condition, reduce postoperative shoulder pain and vomiting. However, there was no significant difference between them on the hepatic perfusion and perioperative liver function. [ABSTRACT FROM AUTHOR]