Eur J Anaesthesiol：拮抗残留神经肌肉阻滞作用后患者预后的回顾性调查：Sugammadex组 ，新斯的明组，不予拮抗剂组

背景：术后残留神经肌肉阻滞发病率非常高

目的：研究拮抗残留神经肌肉阻滞作用对术后结果的影响

环境：西澳大利亚第三教学医院

患者：经伦理委员会同意，本调查采集分析了1444名外科手术中使用至少单次剂量非去极化肌松药的病人数据。

主要方法：

终点：包括麻醉后监护中心非预计的事件、术后7天内肺部并发症的症状（0到100的结果数值基于在温度大于38摄氏度，白细胞数量大于11*10 9/L，检查结果符合肺炎以及呼吸急促）、PACU周转时间以及住院时间长短。

结果：

分析来自1444名病人的数据（sugammadex组：722名、新斯的明组：212名、不拮抗组：510名），新斯的明组的病人发生恶心和呕吐的概率要高于sugammadex组（21.5%比13.6%；p<0.05），对于其他PACU事件未见明显差异，如PACU时间长短和住院时间的长短。随着年龄与ASA机能状态的上升，肺功能下降尤为显著，这一状况在 ASA 3/4级 超过60岁并采用新斯的明拮抗治和不予拮抗的病人中尤为多见。但是在sugammadex组中年龄对于肺部的不良影响几乎没有（p<0.05）。

结论：使用sugammadex拮抗术后残留神经肌肉阻滞所引起的术后恶心率最低，并可以降低 ASA3/4级 大龄病人的肺部并发症的风险。

MedSci翻译，由会员周磊校正。

英文摘要阅读：

Title:Retrospective investigation of postoperative outcome after reversal of residual neuromuscular blockade: Sugammadex, neostigmine or no reversal.

Authors:Ledowski T1, Falke L, Johnston F, Gillies E, Greenaway M, De Mel A, Tiong WS, Phillips M.

BACKGROUND

Postoperative residual neuromuscular blockade (RNMB) is associated with significant morbidity.

OBJECTIVE

The aim of this retrospective data analysis was to investigate the influence of the method of RNMB reversal on postoperative outcome.

SETTING

Tertiary teaching hospital in Western Australia.

PATIENTS

With Ethics Committee approval, data from 1444 patients who received at least one dose of a non-depolarising muscle relaxant intraoperatively during 2011 were analysed.

MAIN OUTCOME MEASURES

Endpoints included unwanted events in the postanaesthesia care unit (PACU); symptoms of pulmonary complications within 7 postoperative days (0 to 100 outcome score based on 'temperature >38°C', 'leucocyte count >11 × 10 l', 'physical examination consistent with pneumonia' and 'shortness of breath'); PACU turnover time; and length of hospital stay.

RESULTS

Data from 1444 patients (722 sugammadex, 212 neostigmine and 510 no-reversal) were analysed. The incidence of postoperative nausea and vomiting (PONV) in PACU was higher in neostigmine-reversed than sugammadex-reversed patients (21.5 vs. 13.6%; P <0.05). No differences were found regarding other PACU incidents, length of PACU stay or hospital stay. Pulmonary outcome deteriorated significantly (outcome score increased) with age and American Society of Anesthesiologists (ASA) physical status. This was observed particularly in ASA 3/4 patients more than 60 years of age in neostigmine-reversed or non-reversed patients, but almost no detrimental effect of age on pulmonary outcome was found in the sugammadex group (P <0.05).

CONCLUSION

RNMB reversal with sugammadex was associated with the lowest rate of PONV and may reduce the risk of pulmonary complications in elderly ASA 3/4 patients.