作者：米勒之声
全身麻醉患者使用神经肌肉阻滞剂拮抗剂的疗效(REVEAL研究)
贵州医科大学 麻醉与心脏电生理课题组
翻译：柏雪
编辑：马艳燕
审校：曹莹
背景：使用神经肌肉阻滞剂 (NMBA) 后监测肌松恢复是避免肌松残留和改善患者预后的关键。Sugammadex 是一种 NMBA拮抗剂，具有良好的药理学特性。但缺乏该药临床实践和监测的真实数据。
方法：我们对2016年1月至2019年12月所有接受全麻经气管插管的成年外科患者进行电子病历分析研究，以研究NMBA和NMBA拮抗剂给药后的变化和时间趋势。
结果：从最初的115046 例手术病人中，我们纳入了 37882 例患者，其中 24583 例 (64.9%) 自发恢复，13299 例 (35.1%)使用NMBA 拮抗剂治疗。NMBA拮抗剂的使用率在4年里翻倍，从25.5%增加到42.5%，主要是由于sugammadex的使用率从17.8%增加到38.3%。罗库溴铵从 58.6% (2016) 增加到 94.5% (2019)。在多变量分析中与 NMBA拮抗剂使用相关的因素是严重肥胖的患者（II 级肥胖 OR 3.33 和 III 级肥胖 OR 11.4，p < 0.001）和ASA评分高的患者(ASA III OR 1.47)。在合并症中，OSAS、哮喘和其他呼吸系统疾病与 NMBA拮抗剂给药的相关性最强。
结论：不受限制的使用sugammadex导致NMBA逆转的药理学作用显著增加，罗库溴铵的使用量也增加。需要更多的研究来确定不受限制的、更安全的NMBA逆转如何影响术中麻醉监测和实施。
原始数据来源：Massimiliano Greco, Pier Francesco Caruso , Giovanni Angelotti , et, al. REVersal of nEuromusculAr bLocking Agents in Patients Undergoing General Anaesthesia (REVEAL Study). J. Clin. Med. 2023, 12, 563.
英文原文：
Reversal of Neuromuscular Blocking Agents in Patients Undergoing General Anaesthesia (REVEAL Study)
Background:Neuromuscular blocking agent (NMBA) monitoring and reversals are key to avoiding residual curarization and improving patient outcomes. Sugammadex is a NMBA reversal with favorable pharmacological properties. There is a lack of real-world data detailing how the diffusion of sugammadex affects anesthetic monitoring and practice.
Methods:We conducted an electronic health record analysis study , including all adult surgical patients undergoing general anesthesia with orotracheal intubation, from January 2016 to December 2019, to describe changes and temporal trends of NMBAs and NMBA reversals administration.
Results:From an initial population of 115,046 surgeries, we included 37,882 procedures, with 24,583 (64.9%) treated with spontaneous recovery from neuromuscular block and 13,299 (35.1%) with NMBA reversals. NMBA reversals use doubled over 4 years from 25.5% to 42.5%, mainly driven by sugammadex use, which increased from 17.8% to 38.3%. Rocuronium increased from 58.6% (2016) to 94.5% (2019). Factors associated with NMBA reversal use in the multivariable analysis were severe obesity (OR 3.33 for class II and OR 11.4 for class III obesity , p-value < 0.001), and high ASA score (OR 1.47 for ASA III). Among comorbidities, OSAS, asthma, and other respiratory diseases showed the strongest association with NMBA reversal administration.
Conclusions:Unrestricted availability of sugammadex led to a considerable increase in pharmacological NMBA reversal, with rocuronium use also rising. More research is needed to determine how unrestricted and safer NMBA reversal affects anesthesia intraoperative monitoring and practice.
免责声明：
本平台所刊载原创或转载内容不代表米勒之声的观点或立场。文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。
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编辑：Michel.米萱
校对：MiLu.米鹭
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