深度神经肌肉阻滞组术中出血量明显少于中度神经肌肉阻滞组；300ml[200~494vs.415ml[240~601]；差异：117ml(95%可信区间，9~244；P=0.044)。深度神经肌肉阻滞组的外科医生对手术条件的满意度高于中度神经肌肉阻滞组；3.5 ± 1.0vs.2.9±0.9(P=0.004)。呼吸变量组间比较，深度神经肌肉阻滞组吸气峰压总体较低(P<0.001)。深度神经肌肉阻滞组术后疼痛评分中位数为50[36~60]，低于中度神经肌肉阻滞组的60[50~70]，差异有统计学意义(P<0.023)。
Kang WS, Oh CS, Rhee KY, et,al.Deep neuromuscular blockade during spinal surgery reduces intra-operative blood loss A randomised clinical trial[J].Eur J Anaesthesiol 2020Mar;37(3)
BACKGROUND Spinal surgery is usually performed in the prone position using a posterior approach. However, the prone position may cause venous engorgement in the back and thus increase surgical bleeding with interruption of surgery. The prone position alsoaffects cardiac output since large vessels are compressed decreasing venous return to the heart.
OBJECTIVE We hypothesised that deep neuromuscular blockade would be associated with less surgical bleeding during spinal surgery in the prone position.
DESIGN Randomised, single blinded trial.
SETTING University teaching hospital.
PARTICIPANTS Eighty-eight patients in two groups.
INTERVENTIONS Patients were randomly assigned to moderate neuromuscular blockade or deep neuromuscular blockade. In the moderate neuromuscular blockade group,administration of rocuronium was adjusted such that the train-of-four count was one to two. In the deep neuromuscular blockade group, rocuronium administration was adjusted such that the train-of-four count was zero with a posttetanic count 2 or less.
MAIN OUTCOME MEASURES The primary outcome was the volume of intra-operative surgical bleeding. The surgeon’s satisfaction with operating conditions,haemodynamic and respiratory status, and postoperative pain scores were evaluated.
RESULTS The median [IQR] volume of intra-operative surgical bleeding was significantly less in the deep neuromuscular blockade group than in the moderate neuromuscular blockade group; 300 ml [200 to 494] vs. 415 ml [240 to 601]; difference: 117 ml (95% CI, 9 to 244; P=0.044). The mean+/-SD surgeon’s satisfaction with the intra-operative surgical conditions was greater in the deep neuromuscular blockade group than in the moderate neuromuscular blockade group; 3.5+/-1.0 vs. 2.9+/-0.9 (P=0.004). In intergroup comparisons of respiratory variables, peak inspiratory pressure was lower in the deep neuromuscular blockade group overall (P<0.001). The median [IQR] postoperative pain score was lower in the deep neuromuscular blockade group than the moderate neuromuscular blockade group; 50 [36 to 60] vs. 60 [50 to 70], (P=0.023).
CONCLUSION Deep neuromuscular blockade reduced intra-operative surgical bleeding in patients undergoing spinal surgery. This may be related to greater relaxation in the back muscles and lower intra-operative peak inspiratory pressure when compared with moderate neuromuscular blockade.
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