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[Lancet Respir Med发表论文]:使用肌松药物增加全麻术后肺部并发症
2019年04月06日 时讯速递, 进展交流 暂无评论

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Eva Kirmeier, Lars I Eriksson, Heidrun Lewald, et al

Lancet Respir Med 2019; 7: 129-140

Background 背景

Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications.

回顾性研究结果提示,使用全麻期间神经肌肉阻滞剂可能与术后肺部并发症有关。因此,我们旨在评估使用神经肌肉阻滞剂是否与术后肺部并发症相关。

Methods 方法

We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients' preoperative physical status, providing adjusted odds ratios (OR adj) and adjusted absolute risk reduction (ARR adj). This study is registered with ClinicalTrials.gov, number NCT01865513.

我们进行了一项多中心,前瞻观察队列研究。欧洲28个国家211家医院的患者入选。我们入选了住院期间接受全麻手术(除心脏外科手术外)的成年患者。我们前瞻性记录患者特征、手术及麻醉信息,并在出院时查阅病历。另外,对于每位患者术后3天内进行术后体格检查以确定是否出现肺部不良事件。研究预后指标为手术结束至术后28天内术后肺部并发症发生率。我们采用logisitic回归分析对手术因素及患者术前身体状况进行校正,结果表示为校正比数比(OR adj)及校正绝对风险降低(ARR adj)。研究在ClinicalTrials.gov注册,注册号NCT01865513

Findings 结果

Between June 16, 2014, and April 29, 2015, data from 22 803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21 694); OR adj 1·86, 95% CI 1·53–2·26; ARR adj −4·4%, 95% CI −5·5 to −3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (OR adj 1·31, 95% CI 1·15–1·49; ARR adj −2·6%, 95% CI −3·9 to −1·4) and the administration of reversal agents (1·23, 1·07–1·41; −1·9%, −3·2 to −0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (OR adj 1·03, 95% CI 0·85–1·25; ARR adj −0·3%, 95% CI −2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; −0·4%, −3·5 to 2·2) was associated with better pulmonary outcomes.

在2014年6月16日至2015年4月29日之间,共收集了22803名患者的数据。对于接受全麻手术的患者,使用神经肌肉阻滞剂伴随术后肺部并发症发生率增加(1658/21694 [7·6%]);OR adj 1·86, 95% CI 1·53–2·26; ARR adj −4·4%, 95% CI −5·5 to −3·2)。仅有2·3%的发生呼吸道不良事件的高危手术患者麻醉期间没有使用肌松药物。神经肌肉监测(OR adj 1·31, 95% CI 1·15–1·49; ARR adj −2·6%, 95% CI −3·9 to −1·4)及使用拮抗药物(1·23, 1·07–1·41; −1·9%, −3·2 to −0·7)并不伴随术后肺部并发症风险降低。选择sugammadex替代新斯的明进行拮抗(OR adj 1·03, 95% CI 0·85–1·25; ARR adj −0·3%, 95% CI −2·4 to 1·5)或4个成串刺激比值不低于0·9时拔管(1·03, 0·82–1·31; −0·4%, −3·5 to 2·2)均与更好的肺部预后不相关。

Interpretation 结论

We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications.

我们发现,全麻期间使用神经肌肉阻滞剂伴随术后肺部并发症风险增加。麻醉医生必须权衡神经肌肉组织的可能获益以及伴随的术后肺部并发症风险增加。

Funding 资助

European Society of Anaesthesiology.

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