【罂粟摘要】新斯的明或舒更葡萄糖逆转残余肌松与术后肺部并发症：一项针对高危老年患者的前瞻性、随机、双盲试验
新斯的明或舒更葡萄糖逆转残余肌松与术后肺部并发症：一项针对高危老年患者的前瞻性、随机、双盲试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：牛振瑛 编辑：潘志军 审校：曹莹
背景
回顾性研究证明，残留的肌松作用与术后肺部并发症的风险增加有关。我们研究的目的是前瞻性地调查高危老年患者应用糖酐(SUG)或新斯的明(NEO)逆转术后肺部并发症的发生率。
方法
随机将180名有明显高危因素(ASA分级III)≥75岁的老年患者分为两组，分别用SUG或NEO拮抗罗库溴铵的肌松作用。比较两组患者在恢复室及术后第1、3、7天发生的不良事件和肺部并发症(结果定义为5个分数段得分[0-4,0分最好，4分最差])。
结果
对168例80±4岁患者的资料进行了分析；SUG组患者术后第7天肺部并发症的发生率降低 (0.052 vs 0.122)，但在第1天和第3天没有差异。NEO组有更多的患者通过影像学确诊为肺炎(9.6%vs2.4%；P=0.046)。所有单个中心中NEO组在住院时间延长(合计9天vs7.5天)方面没有明显的差异，但在马来西亚有显著差异(6天vs 4天；P=0.011)。
在选定的高危老年患者队列中，用SUG逆转罗库溴铵肌松可导致肺部转归的轻微改善，但可能与临床条件改善相关。
原始文献来源：Togioka BM, Yanez D,et，al.Reversal of residual neuromuscular block with neostigmine or sugammadex and postoperative pulmonary complications: a prospective, randomised, double-blind trial in high-risk older patients[J].Br J Anaesth. 2020 May;124(5):553-561.
英文原文👇
Reversal of residual neuromuscular block with neostigmine or sugammadex and postoperative pulmonary complications: a prospective, randomised, double-blind trial in high-risk older Patients
Abstract
Background: Residual neuromuscular block is associated with an increased risk of postoperative pulmonary complications in retrospective studies. The aim of our study was to investigate prospectively the incidence of postoperative pulmonary complications after reversal with either sugammadex (SUG) or neostigmine (NEO) in high-risk older patients.
Methods: We randomly allocated 180 older patients with significant morbidity (ASA physical status 3) ?75 yr old to reversal of rocuronium with either SUG or NEO. Adverse events in the recovery room and pulmonary complications (defined by a 5-point [0-4; 0=best to 4=worst] outcome score) on postoperative Days 1, 3, and 7 were compared between groups.
Results: Data from 168 patients aged 80 (4) yr were analysed; SUG vs NEO resulted in a reduced probability (0.052 vs 0.122) of increased pulmonary outcome score (impaired outcome) on postoperative Day 7, but not on Days 1 and 3. More patients in the NEO group were diagnosed with radiographically confirmed pneumonia (9.6% vs 2.4%; P=0.046). The NEO group showed a non-significant trend towards longer hospital length of stay across all individual centres (combined 9 vs 7.5 days), with a significant difference in Malaysia (6 vs 4 days; P=0.011).
Conclusions: Reversal of rocuronium neuromuscular block with SUG resulted in a small, but possibly clinically relevant improvement in pulmonary outcome in a select cohort of high-risk older patients.