中效非去极化神经肌肉阻滞剂与患者术后30天发病率和死亡率，及长期生存的关系
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Intermediate-Acting Nondepolarizing Neuromuscular Blocking Agents and Risk of Postoperative 30-Day Morbidity and Mortality, and Long-term Survival
背景与目的
非去极化神经肌肉阻滞药（非去极化肌松药）（NNMBD）常作为全身麻醉的辅助用药。 临床上肌松残余较为常见，但其潜在的不利影响尚不完全知晓。 本研究旨在评估非去极化肌松药阻滞剂新斯的明的使用与患者术后发病率、死亡率之及长期生存的关系。
方 法
这是对5所退伍军人医院（VA）医院进行非心脏手术全身麻醉的11,355名成年患者进行的回顾性观察性研究。其中8984例接受NNMBDs，7047例接受新斯的明逆转肌松。 主要结果是呼吸道并发症（脱离呼吸机失败，再次插管肺炎），如果患者有3个事件中的任何一个，则“是“，如果没有，则为“否”。 次要结果是非呼吸道并发症，30天和长期全因死亡率。 我们使用倾向匹配（PM）调整患者风险的差异，然后通过匹配对之间的逻辑回归来评估兴关联，作为我们的主要分析和多变逻辑回归（MLR）作为敏感性分析。
结 果
我们的主要目的是评估接受肌松药使用新斯的明拮抗与否的患者的不良反应。 与NNMD与新斯的明逆转相比，未使用非去极化肌松药治疗与呼吸道并发症的几率增加相关（PM优势比[OR]，1.75 [95％置信区间[CI]，1.23-2.50]; MLR OR，1.71 [CI ，1.24-2.37]）和30天死亡率的边际增加（PM OR，1.83 [CI，0.99-3.37]; MLR OR，1.78 [CI，1.02-3.13]）。 然而，与非呼吸道并发症或长期死亡率无统计学意义。接受新斯的明治疗的NNMBD患者与无NNMBD的全身麻醉患者相比，结果无差异。
结 论
没有使用新斯的明拮抗的非去极化肌松药与使用新斯的明拮抗患者相比，发生呼吸道并发症可能性增加。基于这些数据，我们得出结论，如果计划拔管，非去极化肌松药的拮抗应该成为标准做法。
原始文献摘要
Intermediate-Acting Nondepolarizing Neuromuscular Blocking Agents and Risk of Postoperative 30-Day Morbidity and Mortality, and Long-term Survival[J].Anesth Analg 2018;124:1476–83
BACKGROUND:Nondepolarizing neuromuscular blocking drugs (NNMBDs) are commonly used as an adjunct to general anesthesia. Residual blockade is common, but its potential adverse effects are incompletely known. This study was designed to assess the association between NNMBD use with or without neostigmine reversal and postoperative morbidity and mortality.
METHODS:This is a retrospective observational study of 11,355 adult patients undergoing general anesthesia for noncardiac surgery at 5 Veterans Health Administration (VA) hospitals. Of those, 8984 received NNMBDs, and 7047 received reversal with neostigmine. The primary outcome was a composite of respiratory complications (failure to wean from the ventilator,reintubation, or pneumonia), which was “yes” if a patient had any of the 3 component events and “no” if they had none. Secondary outcomes were nonrespiratory complications, 30-day and long-term all-cause mortality. We adjusted for differences in patient risk using propensity matched (PM) followed by assessment of the association of interest by logistic regression between the matched pairs as our primary analysis and multivariable logistic regression (MLR) as a sensitivity analysis.
RESULTS:Our primary aim was to assess the adverse outcomes in the patients who had received NNMBDs with and without neostigmine. Administration of an NNMBD without neostigmine reversal compared with NNMBD with neostigmine reversal was associated with increased odds of respiratory complications (PM odds ratio [OR], 1.75 [95% confidence interval [CI], 1.23–2.50]; MLR OR, 1.71 [CI, 1.24–2.37]) and a marginal increase in 30-day mortality (PM OR, 1.83[CI, 0.99–3.37]; MLR OR, 1.78 [CI, 1.02–3.13]). However, there were no statistically significant associations with nonrespiratory complications or long-term mortality. Patients who were administered an NNMBD followed by neostigmine had no differences in outcomes compared with patients who had general anesthesia without an NNMBD.
CONCLUSIONS:The use of NNMBDs without neostigmine reversal was associated with increased odds of our composite respiratory outcome compared with patients reversed with neostigmine. Based on these data, we conclude that reversal of NNMBDs should become a standard practice if extubation is planned.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：冯玉蓉 编辑：何幼芹 审校：王贵龙