顺阿曲库铵与罗库溴铵对500例机器人BABA甲状腺切除术中神经监测及推测性机械创伤的影响
Effects of cisatracurium and rocuronium on intraoperative neuromonitoring and putuative mechanical trauma in 500 robotic baba thyroidectomies.
文献信息
| PMID | 42773262 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Daqi Zhang |
| 作者单位 | Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Thyroid Disease, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine On Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China. |
| 期刊 | Surgical endoscopy |
| SCI 分区 | Q1 |
| IF | 3.3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 在采用术中神经监测（IONM）的甲状腺手术中，指南推荐单次插管剂量的神经肌肉阻滞剂（NMBA）接近1×ED95，以平衡插管条件与可靠的肌电图（EMG）信号。然而，在机器人双侧腋窝-乳房入路（BABA）甲状腺切除术中，缺乏触觉反馈引发了担忧：持续的肌肉松弛可能有利于未被识别的喉返神经（RLN）机械创伤。
方法： 我们回顾性分析了2020年4月至2022年10月期间连续接受择期机器人BABA甲状腺切除术并采用IONM的患者。患者在诱导时接受三种NMBA方案之一：顺阿曲库铵0.05 mg/kg（A组）、顺阿曲库铵0.1 mg/kg（B组）或罗库溴铵0.3 mg/kg（C组）。我们比较了插管条件、血流动力学、麻醉需求、RLN和迷走神经EMG振幅（V1、R1、R2、V2）以及围手术期结局，包括RLN麻痹、引流量、疼痛和住院时间。
结果： 共纳入500例机器人BABA甲状腺切除术（A组：n=459；B组：n=20；C组：n=21）。在所有组中，插管条件始终为优或良。V1、R1、R2和V2的平均EMG振幅保持在被认为足以进行可靠IONM的范围内，各NMBA方案之间无显著差异。在A组中，短暂性RLN麻痹发生于2.4%的患者，并在6个月内完全恢复；未观察到永久性RLN麻痹。B组和C组未记录到RLN损伤，尽管这些队列样本量小。血流动力学特征总体稳定；与顺阿曲库铵0.1 mg/kg相比，顺阿曲库铵0.05 mg/kg与拔管时血压和心率波动较小相关。各组间引流量、疼痛评分、美容满意度和住院时间相当。
结论： 在采用IONM的机器人BABA甲状腺切除术中，单次低剂量顺阿曲库铵0.05 mg/kg提供了优良的插管条件、稳定的EMG信号和较低的RLN并发症，尽管缺乏力反馈，但无证据表明机械创伤增加。在本系列中，较高剂量顺阿曲库铵和罗库溴铵0.3 mg/kg产生了相似的EMG和临床结局，但由于样本量小，应将其解释为探索性。这些发现支持低剂量顺阿曲库铵作为采用IONM的机器人甲状腺手术中实用且符合指南的NMBA策略。
英文摘要
BACKGROUND: In thyroid surgery with intraoperative neuromonitoring (IONM), guidelines recommend a single intubating dose of neuromuscular blocking agent (NMBA) close to 1 × ED95 to balance intubation conditions and reliable electromyographic (EMG) signals. In robotic bilateral axillo-breast approach (BABA) thyroidectomy, however, the absence of haptic feedback raises concerns that persistent muscle relaxation could favor unrecognized mechanical trauma to the recurrent laryngeal nerve (RLN).
METHODS: We retrospectively analyzed consecutive patients undergoing elective robotic BABA thyroidectomy with IONM between April 2020 and October 2022. Patients received one of three NMBA regimens at induction: cisatracurium 0.05 mg/kg (group A), cisatracurium 0.1 mg/kg (group B), or rocuronium 0.3 mg/kg (group C). We compared intubation conditions, hemodynamics, anesthetic requirements, RLN and vagus EMG amplitudes (V1, R1, R2, V2), and perioperative outcomes, including RLN palsy, drainage, pain, and hospital stay.
RESULTS: Five hundred robotic BABA thyroidectomies were included (group A: n = 459; group B: n = 20; group C: n = 21). Across all groups, intubation conditions were consistently excellent or good. Mean EMG amplitudes for V1, R1, R2, and V2 remained within the range considered adequate for reliable IONM, with no significant differences between NMBA regimens. In group A, transient RLN palsy occurred in 2.4% of patients and resolved completely by 6 months; no permanent RLN palsy was observed. No RLN injuries were recorded in groups B and C, although these cohorts were small. Hemodynamic profiles were generally stable; cisatracurium 0.05 mg/kg was associated with less fluctuation in blood pressure and heart rate at extubation compared with cisatracurium 0.1 mg/kg. Drainage volumes, pain scores, cosmetic satisfaction, and hospital stay were comparable among groups.
CONCLUSIONS: In robotic BABA thyroidectomy with IONM, a single low dose of cisatracurium 0.05 mg/kg provides excellent intubation conditions, stable EMG signals, and low RLN morbidity, without evidence of increased mechanical trauma despite the lack of force feedback. Higher cisatracurium dose and rocuronium 0.3 mg/kg yielded similar EMG and clinical outcomes in this series, but should be interpreted as exploratory due to small sample size. These findings support low-dose cisatracurium as a practical, guideline-consistent NMBA strategy for robotic thyroid surgery with IONM.