在老年患者中逆转神经肌肉阻塞的neostigmine与sugammadex:一个盲目的随机研究
Matias Vested1,2, Sarah Sofie Wadland1, Michelle Icka Christensen1
1Department of Anaesthesia, Centre of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
与neostigmine相比,在老年患者中,sugammadex显著加快了与rocuronium阻塞后的神经肌肉功能恢复的速度. 这项研究强调了sugammadex作为这个人群更快,更可预测的逆转剂.
科学领域:
- 麻醉学和外科手术期间的医学.
- 药理学和药物行动 药理学和药物行动
- 老年医学 老年医学
背景情况:
- 使用neostigmine或sugammadex逆转神经肌肉阻塞 (NMB) 对于预防手术后残留的NMB至关重要.
- 在成年人中,Sugammadex提供了更快的逆转和比neostigmine更少的副作用.
- 关于老年患者的罗库-NMB逆转和肌肉功能恢复的数据有限.
研究的目的:
- 为了比较在老年患者 (≥75岁) 中的苏加马德克斯与新司格明逆转后,神经肌肉功能完全恢复的时间 (Train of Four比率[TOF] ≥0.9).
- 评估苏加马德克斯2毫克/千克与尼奥斯蒂格明50微克/千克对逆转罗库诱导的中度NMB的疗效.
- 评估老年手术患者神经肌肉恢复的可预测性.
主要方法:
- 一个随机试验,涉及41名老年患者 (ASA I-IV) 接受机器人辅助手术,在全静脉麻醉中使用罗库.
- 当TOF比率<0.60时,患者接受了neostigmine/glycopyrrolate (50/10μg/kg) 或sugammadex (2 mg/kg) 治疗,以扭转NMB.
- 主要结果:到TOF的时间≥0.9. 二级结局:在90分钟内出现残留NMB的临床症状.
主要成果:
- 与neostigmine/glycopyrrolate (573s ± 501s) 相比,sugammadex导致TOF≥0.9的时间显著缩短 (147s ± 100s).
- 恢复时间的差异为427秒,有利于sugammadex.
- 两组之间没有观察到残留NMB的临床症状发生的显著差异.
结论:
- 苏加马德克斯 (2毫克/千克) 在接受罗库的老年患者中,与新斯蒂格明/葡萄糖酸盐 (50/10微克/千克) 相比,提供更快的神经肌肉功能恢复.
- 在老年人队伍中,neostigmine逆转显示了恢复时间的显著变化.
- 在老年手术患者中,Sugammadex表现出更可预测的逆转效应.
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