ugammadex对重症肌无力患者术后肌无力危象的影响
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Effect of Sugammadex on Postoperative Myasthenic Crisis in Myasthenia Gravis Patients: Propensity Score
Analysis of a Japanese Nationwide Database
背景与目的
因为重症肌无力（MG）患者术后肌无力危象和残余神经肌肉阻断剂（NMBA）可导致呼吸衰竭，因此其需要机械通气。然而，尚不清楚使用Sugammadex逆转NMBA是否能减少MG患者手术后的肌无力危象。我们利用全国住院患者数据库分析了Sugammadex与MG患者术后肌无力危象的关系。
方 法
在2010年7月1日至2016年3月31日的日本诊断程序组合数据库中确定了在全身麻醉下接受胸腺切除术的MG成年患者。将接受Sugammadex治疗的患者（Sugammadex治疗组）与未接受其治疗的患者（对照组）进行比较。主要结果是术后肌无力危象，次要结果是术后肺炎、气管切开术、28天死亡率、总住院费用和术后住院时间。倾向性评分是基于以下变量的logistic回归评估的：年龄；性别；体重指数（BMI）；吸烟指数；癌症史；Charlson共病指数（CCI）；胸腺切除术类型；入院至手术时间；术前血浆交换、免疫抑制剂、皮质类固醇、抗胆碱酯酶和口服苯二氮卓；医院类型；治疗年份。使用稳定的治疗负概率加权（IPTW）分析比较结果，以获得良好的组间平衡。
结 果
在795名患者中，506名患者接受了Sugammadex治疗，289名患者没有接受。当稳定IPTW后，与对照组相比，Sugamadex组术后肌无力危象减少，（22/507[4.3%]vs 25/288[8.7%]；比值比[OR]，0.48；95%可信区间[CI]，0.25-0.91），但与术后肺炎减少（5/507[1.0%]vs 7/288[2.4%]；OR，0.44；95%CI，0.17-1.14）或气管切开术无关（7/507[1.4%]对10/288[3.5%]；或，0.38；95%可信区间，0.12-1.22）。Sugammadex组的总住院费用中位数($13,186 [$11,250–$16,988] vs $14,119 [$11,713–$20,207]; P < .001)和术后住院时间中位数 (10 [8–15] vs 11 [8–18] days; P < .001)明显低于对照组。
结 论
在这项回顾性的观察研究中，Sugamadex与胸腺切除术后MG患者的术后肌无力危象和总住院费用的减少相关。鉴于目前的研究结果，Sugamadex应常规用于接受胸腺切除术的MG患者。
原始文献摘要
Hideyuki Mouri,Taisuke Jo, Hiroki Matsui, et al.Effect of Sugammadex on Postoperative Myasthenic Crisis in Myasthenia Gravis Patients: Propensity Score Analysis of a Japanese Nationwide Database.Anesth Analg 2020;130:367–73.
BACKGROUND: In myasthenia gravis (MG) patients, postoperative myasthenic crisis, and residual neuromuscular blocking agent (NMBA) can cause respiratory failure that requires mechanical ventilation. However, it remains unclear whether the use of sugammadex for NMBA reversal reduces postoperative myasthenic crisis in MG patients undergoing surgery. We analyzed the association between use of sugammadex and postoperative myasthenic crisis in patients with
MG using a national inpatient database.
METHODS: Adult patients with MG who received thymectomy under general anesthesia were identified in the Japanese Diagnosis Procedure Combination database from July 1, 2010 to March 31, 2016. Patients who received sugammadex (sugammadex group) were compared with those who did not receive sugammadex (control group). The primary outcome was postoperative myasthenic crisis, and the secondary outcomes were postoperative pneumonia, tracheostomy,
28-day mortality, total hospitalization costs, and length of stay after surgery. Propensity scores were estimated by logistic regression based on the following variables: age; sex; body mass index (BMI); smoking index; history of cancer; Charlson comorbidity index (CCI); type of thymectomy; time from hospital admission to surgery; use of plasma exchange, immunosuppressants,
corticosteroids, anticholinesterase, and oral benzodiazepine before surgery; type of hospital; and treatment year. The outcomes were compared using stabilized inverse probability of treatment weighting (IPTW) analyses to obtain good between-group balance.
RESULTS: Of 795 patients identified, 506 patients received sugammadex and 289 patients did not. After stabilized IPTW, the sugammadex group was associated with a decrease in postoperative myasthenic crisis (22/507 [4.3%] vs 25/288 [8.7%]; odds ratio [OR], 0.48; 95% confidence interval [CI], 0.25–0.91), but not associated with a decrease in postoperative pneumonia (5/507 [1.0%] vs 7/288 [2.4%]; OR, 0.44; 95% CI, 0.17–1.14) or tracheostomy (7/507 [1.4%] vs 10/288 [3.5%]; OR, 0.38; 95% CI, 0.12–1.22) compared with the control group. The sugammadex group had significantly lower median (interquartile range) total hospitalization costs
($13,186 [$11,250–$16,988] vs $14,119 [$11,713–$20,207]; P < .001) and median length of stay after surgery (10 [8–15] vs 11 [8–18] days; P < .001), compared with the control group.
CONCLUSIONS: In this retrospective observational study, sugammadex was associated with reductions in postoperative myasthenic crisis and total hospitalization costs in adult patients with MG who received thymectomy. Given the present findings, sugammadex should be routinely administered for MG patients undergoing thymectomy.
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翻译：任文鑫 编辑：冯玉蓉 审校：王贵龙