【罂粟摘要】舒更葡糖钠与新斯的明用于重度肾功能损害患者神经肌肉阻滞逆转的效果比较

尽管舒更葡糖钠不建议用于重度肾功能损害的患者，但在其他多种人群中，它已被证明在逆转神经肌肉阻滞方面优于新斯的明。本研究的目的旨在重度肾功能损害的患者中，比较舒更葡糖钠与新斯的明对罗库溴铵诱导的神经肌肉阻滞逆转，是否能更快恢复至四个刺激（TOF）比率≥90%。

作者在一家大型医院开展了一项前瞻性、随机、双盲、对照研究。共有49名患者参与研究，纳入标准包括年龄≥18岁，美国麻醉医师协会（ASA）分级为III或IV，肌酐清除率<30 mL/min，接受全身麻醉，预期手术时间≥2小时并需要神经肌肉阻滞的患者。受试者接受0.2 mg/kg的罗库溴铵或0.6 mg/kg的罗库溴铵进行麻醉诱导插管。术中保持中度神经肌肉阻滞，逆转时分别给予2 mg/kg的舒更葡糖钠或50 µg/kg的新斯的明和10 µg/kg的胃长宁。通过肌电图（TwitchView）进行神经肌肉监测，每分钟记录一次TOF比率。记录从给予逆转剂到患者恢复至TOF比率≥90%的时间作为主要结果。

舒更葡糖钠组恢复至TOF比率≥90%的平均时间为3.5（±1.6）分钟，显著快于新斯的明组的14.8（±6.1）分钟（P < 0.0001；平均差异为11.3分钟；95%置信区间[CI]为9.0-13.5分钟）。两组均未出现重大不良事件。

与新斯的明相比，在重度肾功能损害患者使用罗库溴铵神经肌肉阻滞后，使用舒更葡糖钠逆转能更快地恢复神经肌肉功能，且无重大不良反应。

原始文献来源：Oh MW, Mohapatra SG, Pak T,et,al. Sugammadex Versus Neostigmine for Reversal of Neuromuscular Blockade in Patients With Severe Renal Impairment: A Randomized, Double-Blinded Study[J]. Anesth Analg, 2024 May,138(5):1043-1051. doi: 10.1213/ANE.0000000000006807. 

Sugammadex Versus Neostigmine for Reversal of Neuromuscular Blockade in Patients With Severe Renal Impairment: A Randomized, Double-Blinded Study

Abstract

Background: Sugammadex is not advised for patients with severe renal impairment, but has been shown in a variety of other populations to be superior to neostigmine for reversal of neuromuscular blockade. The objective of this study was to determine if reversal of rocuronium-induced neuromuscular blockade with sugammadex versus reversal of cisatracurium-induced neuromuscular blockade with neostigmine results in a faster return to a train-of-four ratio (TOFR) ≥90% in patients with severe renal impairment.

Methods: We conducted a prospective, randomized, blinded, controlled trial at a large county hospital. A total of 49 patients were enrolled. Inclusion criteria included patients age ≥18, American Society of Anesthesiologists (ASA) physical status III and IV, with a creatinine clearance <30 mL/min, undergoing general anesthesia with expected surgical duration ≥2 hours and necessitating neuromuscular blockade. Subjects received either cisatracurium 0.2 mg/kg or rocuronium 0.6 mg/kg for induction of anesthesia to facilitate tracheal intubation. Subjects were kept at moderate neuromuscular blockade during surgery and received either 2 mg/kg sugammadex or 50 µg/kg neostigmine with 10 µg/kg glycopyrrolate for reversal of neuromuscular blockade. Neuromuscular monitoring was performed with electromyography (TwitchView), and the TOFR was recorded every minute after administration of the reversal agent. The time from administration of neuromuscular reversal until the patient reached a TOFR ≥90% was recorded as the primary outcome.

Results: The mean time to recovery of TOFR ≥90% was significantly faster with sugammadex at 3.5 (±1.6) min compared with neostigmine at 14.8 (±6.1) min ( P < .0001; mean difference, 11.3 minutes; 95% confidence interval [CI], 9.0-13.5 minutes). There were no major adverse events in either group.

Conclusions: In patients with severe renal impairment, neuromuscular blockade with rocuronium followed by reversal with sugammadex provides a significantly faster return of neuromuscular function compared to cisatracurium and neostigmine, without any major adverse effects.