目的 机器人辅助腹腔镜手术在极度头低位下，比较持续深肌松和常规肌松管理方案对患者术后肩痛的影响。 方法 选择18 ~ 80岁、ASA分级Ⅰ ~ Ⅱ级，BMI 18 ~ 30 kg/m²的机器人辅助腹腔镜手术患者100例，随机分为持续深肌松组（D组）和常规肌松组（C组），每组50例。D组术中维持肌松于强直刺激后计数（post-tetanic count， PTC）1 ~ 2，C组术中维持四个成串刺激（train of four stimulation， TOF）值1 ~ 2。手术结束时酌情给予舒更葡糖钠拮抗。首要观察指标为术后72 h内肩痛的发生情况，次要观察指标包括术中术野显露Leiden评分、外科医生要求追加肌松次数、术后肌松恢复情况、苏醒期恶心呕吐评分、PACU内及术后24、48、72 h静卧和翻身时的VAS评分、术后肺部并发症发生率、住院时间、患者满意度评分。 结果 D组术后出现肩痛的患者较C组显著降低（D组 32% vs. C组 56%，P < 0.05）；两组术后肩痛VAS评分差异无统计学意义（P > 0.05）。两组患者术中Leiden评分、外科医师要求追加肌松次数、PACU内恶心呕吐及VAS评分差异无统计学意义（P > 0.05）。术后24 h翻身时的VAS评分D组优于C组（P < 0.05）；其他时间点静卧及翻身时的VAS评分两组无差异统计学意义（P > 0.05）。两组在术后肺部并发症发生率、住院时间及满意度评分方面差异无统计学意义（P > 0.05）。 结论 对于极度头低位下机器人辅助腹腔镜手术患者，术中持续深肌松能降低术后肩痛的发生率。

Objective To compare the impact of continuous profound neuromuscular blockade versus conventional neuromuscular blockade on postoperative shoulder pain in patients undergoing robot?assisted laparoscopic surgery during steep Trendelenburg position. Methods This study was a single?center， randomized， double?blind clinical trial. The inclusion criteria encompassed individuals aged between 18 and 80 years， with an American Society of Anesthesiologists status of Ⅰ or Ⅱ， and a body mass index ranging from 18 kg/m² to 30 kg/m². A total of one hundred patients were randomly assigned to either the deep neuromuscular blockade group （D group） or the conventional neuromuscular blockade group （C group）， with equal distribution of fifty cases in each group. Rocuronium dosage was titrated to achieve post?tetanic count values of 1 ~ 2 and train?of?four stimulation levels of 1 ~ 2 during surgery for D and C groups respectively. At the end of surgery， sugammadex was administered for reversal of neuromuscular blockade. The primary endpoint assessed the incidence of postoperative shoulder pain within three days after surgery. Secondary endpoints included Leiden score evaluation during intraoperative period， number of additional neuromuscular blockers required by the surgeon， recovery time for muscle relaxation postoperatively， nausea and vomiting scores during recovery phase， visual analog scale （VAS） scores in Post?Anesthesia Care Unit （PACU） as well as within three days after surgery， incidence rate for postoperative pulmonary complications， length of hospital stay duration and patient satisfaction score. Results The incidence of postoperative shoulder pain was significantly lower in group D compared to group C （D group 32% vs. C group 56%；P < 0.05）. However， there were no significant differences in postoperative shoulder pain VAS scores between the two groups （P > 0.05）. No significant differences were observed between the groups in terms of Leiden score， surgeon's requirement for additional neuromuscular blockers， nausea and vomiting in PACU， and VAS score （P > 0.05）. Group D exhibited better early postoperative activity pain scores than group C （P < 0.05）. There were no significant differences in VAS scores between the groups at other time points （P > 0.05）. Furthermore， there were no significant differences in the incidence of postoperative pulmonary complications， length of stay， and satisfaction scores between the two groups. Conclusion The implementation of continuous deep neuromuscular blockade in patients undergoing robot?assisted laparoscopic surgery with steep Trendelenburg position can effectively mitigate the occurrence of postoperative shoulder pain.