随机临床试验研究麻醉方案对需要小肠吻合的腹腔镜手术期间肠道动力的影响。

Randomized clinical trial on the influence of anaesthesia protocol on intestinal motility during laparoscopic surgery requiring small bowel anastomosis.

机构信息

Department of Anaesthesia, Groeninge Hospital, Kortrijk, Belgium.

出版信息

Br J Surg. 2012 Nov;99(11):1524-9. doi: 10.1002/bjs.8883. Epub 2012 Sep 21.

DOI:10.1002/bjs.8883

PMID:23001752

Abstract

BACKGROUND

Hyperperistalsis of the small bowel during laparoscopic surgery may cause mucosal prolapse and reduce exposure, making laparoscopic suturing or stapling more demanding for the surgeon. Although it is commonly accepted that both opioids and volatile anaesthetics induce intestinal paralysis, intestinal hyperactivity during anaesthesia is not uncommon. This randomized trial investigated the effect of different volatile anaesthetics on intestinal motility and the impact on surgeon satisfaction.

METHODS

Patients scheduled for laparoscopic gastric bypass surgery were randomized to receive sevoflurane or desflurane in a balanced anaesthetic regimen. After surgical exposure peristaltic waves were counted over 1 min in a segment of the jejunum. Following evaluation of intestinal motility, N-butylhyoscine, an antimuscarinic anticholinergic agent that relaxes bowel smooth muscle cells, could be administered if the surgeon judged the intestinal motility as disturbing. The endpoints were number of peristaltic waves and incidence of N-butylhyoscine administration, a surrogate for surgeon satisfaction.

RESULTS

Twenty-two patients were randomized to each group. The groups were similar in age, sex and body mass index. There was a statistically significant difference in intestinal motility between the desflurane and sevoflurane groups: median (range) 7 (0-12) versus 1 (0-10) waves counted over 1 min respectively (P < 0·001). A higher proportion of patients in the desflurane group received N-butylhyoscine (10 of 22 versus 1 of 22 in the sevoflurane group; P = 0·004).

CONCLUSION

Desflurane increased intestinal motility and decreased surgeon satisfaction compared with sevoflurane during laparoscopic gastric bypass surgery. A sevoflurane-based anaesthetic protocol can help to avoid disturbing hyperperistalsis.

REGISTRATION NUMBER

B39620097060 (http://www.clinicaltrials.be).

摘要

背景

腹腔镜手术中小肠的蠕动过度可能导致黏膜脱垂并减少暴露，使外科医生进行腹腔镜缝合或吻合更加困难。尽管人们普遍认为阿片类药物和挥发性麻醉剂都会引起肠道瘫痪，但麻醉期间肠道活动过度并不少见。本随机试验研究了不同挥发性麻醉剂对肠道动力的影响及其对外科医生满意度的影响。

方法

计划接受腹腔镜胃旁路手术的患者随机分为七氟醚或地氟醚组，在平衡麻醉方案下接受治疗。在手术暴露后，在空肠的一段上计数 1 分钟内的蠕动波。在评估肠道动力后，如果外科医生认为肠道动力令人困扰，可以给予丁溴酸东莨菪碱，一种松弛肠平滑肌细胞的抗毒蕈碱抗胆碱能药物。终点是蠕动波的数量和丁溴酸东莨菪碱的使用情况，这是外科医生满意度的替代指标。

结果

22 名患者随机分为两组。两组在年龄、性别和体重指数方面相似。地氟醚组和七氟醚组的肠道动力存在统计学显著差异：中位数（范围）分别为 7（0-12）次和 1（0-10）次/分钟（P<0·001）。地氟醚组中有更多的患者接受了丁溴酸东莨菪碱（22 名患者中有 10 名，而七氟醚组中有 1 名；P=0·004）。