总结机器人辅助经口腔前庭入路甲状腺手术的麻醉管理经验。方法：回顾2017年12月—2021年4月陆军特色医学中心开展的机器人辅助经口腔前庭入路甲状腺手术41例，分析患者颈部注入二氧化碳（CO2）后生理功能的变化。按照术中4个成串刺激（Train-of-four stimulation，TOF）计数将患者分为两组，根据肌松程度对患者术中并发症和术后拔管时间的影响进行分析。结果：患者颈部注入CO2后，呼吸末二氧化碳（ETCO2）和心率立即升高，30min后达到平台期；26例（63%）出现皮下气肿，28例（68%）出现高碳酸血症；术中4个成串刺激（TOF计数）>0的病例中81%（17/21）出现皮下气肿，TOF计数≤0的患者中45%出现皮下气肿（9/20），TOF计数≤0的患者与TOF计数>0的患者术后拔管时间比较，差异无统计学意义（P>0.05）。结论：机器人辅助经口腔前庭入路甲状腺手术中颈部注入CO2可引起皮下气肿和高碳酸血症，深度肌松可降低皮下气肿和高碳酸血症的发生率。

To summarize the experiences of anesthesia management on transoral robotic thyroidectomy vestibular approach. Methods: 41 cases of transoral robotic thyroidectomy performed in Daping Hospital of Army Medical University from December 2017 to April 2021 were reviewed, and the changes of physiological function after cervical injection of CO2 were analyzed. 41 patients were divided into two groups according to the number of intraoperative Train-of-Four Stimulation (TOF). Effects on intraoperative complications and postoperative extubation time were analyzed based on the degree of muscle relaxation. Results: After cervical injection of CO2, the end-expiratory CO2 and heart rate increased immediately and reached the peak 30min after. 26 cases (63%) of subcutaneous emphysema and 28 cases (68%) of hypercapnia occurred. Subcutaneous emphysema occurred in 81.0% of patients with TOF count> 0 during the operation, and subcutaneous emphysema occurred in 45% of patients with TOF count ≤ 0. No significant difference was found on postoperative extubation time between patients

with TOF count ≤ 0 and patients with TOF count> 0. Conclusion: Cervical injection of CO2 in transoral robotic thyroidectomy vestibular approach could cause subcutaneous emphysema and hypercapnia, while deep muscle relaxation could reduce the incidence of subcutaneous emphysema and hypercapnia.

收稿日期：2021-07-26 录用日期：2022-01-09

Received Date: 2021-07-26 Accepted Date: 2022-01-09

通讯作者：任运钦，Email：renyunqin@126.com

Corresponding Author: Ren Yunqin, Email: renyunqin@126.com

引用格式：王平，毛庆祥，任运钦.机器人辅助经口腔前庭入路甲状腺手术麻醉的管理[J]. 机器人外科学杂志（中英文），2022，3（4）：273-279.

Citation: WANG P, MAO Q X, REN Y Q. Anesthesia management on transoral robotic thyroidectomy vestibular approach[J]. Chinese Journal of Robotic Surgery, 2022, 3(4): 273-279.

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