舒更葡糖钠与新斯的明用于拮抗神经肌肉阻滞对术后肺部并发症的影响：多中心配对队列分析
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
Sugammadex versus Neostigmine for Reversal of Neuromuscular Blockade and Postoperative Pulmonary Complications (STRONGER): A Multicenter Matched Cohort Analysis.
背景与目的
在接受非心脏手术的成年住院患者中，有5 %的患者发生了主要的肺部并发症。因此，本研究旨在验证，使用神经肌肉阻滞剂（新斯的明vs舒更葡糖钠）拮抗可能降低主要肺部并发症的发生率。
方 法
本研究为一项多中心观察性配对队列研究。纳入美国某医院气管插管全麻下行择期非心脏外科手术且接受非去极化神经肌肉阻滞剂和拮抗的成年患者。精确匹配的标准包括机构、性别、年龄、合并症、肥胖、手术类型和神经肌肉阻滞剂(罗库溴铵与维库溴铵)。在残余神经肌肉阻滞下，对术前和术中的其他因素进行比较与校正。复合主要结局为主要的术后肺部并发症，定义为肺炎、呼吸衰竭或其他肺部并发症(包括肺炎、肺充血、医源性肺栓塞、肺梗死或气胸)。次要结局集中在肺炎和呼吸衰竭的组成部分上。
结 果
在30026例接受舒更葡糖钠拮抗的患者中，有22856例与接受新斯的明拮抗的22856例患者相配对。45 712例患者中，1 892例(4.1 %)被诊断为肺炎、呼吸衰竭或其他肺部并发症(舒更葡糖钠组3.5 % vs. 新斯的明组4.8%)。其中，共有796例(1.7 %)患者出现肺炎(1.3 % vs. 2.2 %)，582例(1.3%)患者出现呼吸衰竭(0.8 % vs. 1.7%)。在多变量分析中，与新斯的明相比，舒更葡糖钠可降低30 %的肺部并发症发生风险(调整比值比为0.70; 95 % CI, 0.63 - 0.77)，47 %的肺炎发生风险(调整比值比为0.53; 95 % CI, 0.44 - 0.62)和55 %的呼吸衰竭发生风险 (调整比值比为0.45; 95 % CI, 0.37 - 0.56)。
结 论
本研究发现，使用舒更葡糖钠在临床上和统计学上可显著降低主要肺部并发症的发生率。
原始文献摘要
Kheterpal S, Vaughn MT, Dubovoy TZ, et al. Sugammadex versus Neostigmine for Reversal of Neuromuscular Blockade and Postoperative Pulmonary Complications (STRONGER): A Multicenter Matched Cohort Analysis[J]. Anesthesiology, 2020, 132: 1371-1381.
BACKGROUND:Five percent of adult patients undergoing noncardiac inpatient surgery experience a major pulmonary complication. The authors hypothesized that the choice of neuromuscular blockade reversal (neostigmine vs. sugammadex) may be associated with a lower incidence of major pulmonary complications.
METHODS:Twelve U.S. Multicenter Perioperative Outcomes Group hospitals were included in a multicenter observational matched-cohort study of surgical cases between January 2014 and August 2018. Adult patients undergoing elective inpatient noncardiac surgical procedures with general anesthesia and endotracheal intubation receiving a nondepolarizing neuromuscular blockade agent and reversal were included. Exact matching criteria included institution, sex, age, comorbidities, obesity, surgical procedure type, and neuromuscular blockade agent (rocuronium vs. vecuronium). Other preoperative and intraoperative factors were compared and adjusted in the case of residual imbalance. The composite primary outcome was major postoperative pulmonary complications, defined as pneumonia, respiratory failure, or other pulmonary complications (including pneumonitis; pulmonary congestion; iatrogenic pulmonary embolism, infarction, or pneumothorax). Secondary outcomes focused on the components of pneumonia and respiratory failure.
RESULTS:Of 30,026 patients receiving sugammadex, 22,856 were matched to 22,856 patients receiving neostigmine. Out of 45,712 patients studied, 1,892 (4.1%) were diagnosed with the composite primary outcome (3.5% sugammadex vs. 4.8% neostigmine). A total of 796 (1.7%) patients had pneumonia (1.3% vs. 2.2%), and 582 (1.3%) respiratory failure (0.8% vs. 1.7%). In multivariable analysis, sugammadex administration was associated with a 30% reduced risk of pulmonary complications (adjusted odds ratio, 0.70; 95% CI, 0.63 to 0.77), 47% reduced risk of pneumonia (adjusted odds ratio, 0.53; 95% CI, 0.44 to 0.62), and 55% reduced risk of respiratory failure (adjusted odds ratio, 0.45; 95% CI, 0.37 to 0.56), compared to neostigmine.
CONCLUSIONS:Among a generalizable cohort of adult patients undergoing inpatient surgery at U.S. hospitals, the use of sugammadex was associated with a clinically and statistically significant lower incidence of major pulmonary complications.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：何幼芹 编辑：冯玉蓉 审校：王贵龙