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新斯的明或舒更葡糖促进罗库溴铵神经肌肉阻滞恢复期间膈肌的肌电图活动：一项在健康志愿者中的随机对照研究。

Electromyographic activity of the diaphragm during neostigmine or sugammadex-enhanced recovery after neuromuscular blockade with rocuronium: a randomised controlled study in healthy volunteers.

作者信息

Schepens Tom, Cammu Guy, Saldien Vera, De Neve Nikolaas, Jorens Philippe G, Foubert Luc, Vercauteren Marcel

机构信息

From the Department of Anaesthesiology, Antwerp University Hospital, Antwerp (TS, VS, MV), Department of Anaesthesiology and Critical Care Medicine, Onze-Lieve-Vrouw Ziekenhuis, Aalst (GC, NDN, LF), and Department of Critical Care Medicine, Antwerp University Hospital, Antwerp, Belgium (PGJ).

出版信息

Eur J Anaesthesiol. 2015 Jan;32(1):49-57. doi: 10.1097/EJA.0000000000000140.

DOI:10.1097/EJA.0000000000000140

PMID:25111539

Abstract

BACKGROUND

The use of neuromuscular blocking agents has been associated with severe postoperative respiratory morbidity. Complications can be attributed to inadequate reversal, and reversal agents may themselves have adverse effects.

OBJECTIVE

To compare the electromyographic activity of the diaphragm (EMGdi) during recovery from neuromuscular blockade using neostigmine and sugammadex. The hypothesis was that there would be better neuromuscular coupling of the diaphragm when sugammadex was used.

DESIGN

A randomised, controlled, parallel-group, single-centre, double-blinded study.

SETTING

District general hospital in Belgium.

PARTICIPANTS

Twelve healthy male volunteers.

INTERVENTIONS

Individuals were anaesthetised with propofol and remifentanil. After rocuronium 0.6 mg kg, a transoesophageal electromyography (EMG) recorder was inserted. For reversal of neuromuscular blockade, volunteers received sugammadex 2 mg kg (n = 6) or neostigmine 70 μg kg (n = 6).

MAIN OUTCOME MEASURES

EMGdi, airway pressure and flow were continuously measured during weaning from the ventilator until tracheal extubation. Arterial blood gas samples were obtained for PaO2 and PaCO2 analysis at the first spontaneous breathing attempt and after tracheal extubation.

RESULTS

During weaning, 560 breaths were retained for analysis. The median (95% CI) peak EMGdi was 1.1 (0.9 to 1.5) μV in the neostigmine group and 1.6 (1.3 to 1.9) μV in the sugammadex group (P < 0.001). Individuals in the neostigmine group had 125 of 228 (55%) breaths with associated EMGdi at least 1 μV vs. 220 of 332 (66%) breaths in the sugammadex group (P = 0.008). The median (95% CI) tidal volume was 287 (256 to 335) ml after neostigmine and 359 (313 to 398) ml after sugammadex (P = 0.013). The median (95% CI) PaO2 immediately after extubation was 30.5 (22.8 to 37.1) kPa after sugammadex vs. 20.7 (12.9 to 27.5) kPa after neostigmine (P = 0.03).

CONCLUSION

EMGdi, tidal volume and PaO2 following tracheal extubation were increased after sugammadex compared with neostigmine, reflecting diaphragm-driven inspiration after sugammadex administration. Sugammadex may free more diaphragmatic acetylcholine receptors than neostigmine, which has an indirect effect.

TRIAL REGISTRATION

EudraCT ref: 2013-002078-30.

摘要

背景

使用神经肌肉阻滞剂与严重的术后呼吸并发症相关。并发症可能归因于逆转不完全，而逆转剂本身可能也有不良反应。

目的

比较使用新斯的明和舒更葡糖在神经肌肉阻滞恢复过程中膈肌的肌电图活动（EMGdi）。假设是使用舒更葡糖时膈肌的神经肌肉耦联会更好。

设计

一项随机、对照、平行组、单中心、双盲研究。

地点

比利时的地区综合医院。

参与者

12名健康男性志愿者。

干预措施

用丙泊酚和瑞芬太尼对个体进行麻醉。给予罗库溴铵0.6mg/kg后，插入经食管肌电图（EMG）记录仪。为逆转神经肌肉阻滞，志愿者接受舒更葡糖2mg/kg（n = 6）或新斯的明70μg/kg（n = 6）。

主要观察指标

在从呼吸机撤离直至气管拔管期间，持续测量EMGdi、气道压力和流量。在首次自主呼吸尝试时和气管拔管后采集动脉血气样本进行PaO2和PaCO2分析。

结果

在撤离过程中，保留560次呼吸用于分析。新斯的明组EMGdi峰值的中位数（95%CI）为1.1（0.9至1.5）μV，舒更葡糖组为1.6（1.3至1.9）μV（P < 0.001）。新斯的明组228次呼吸中有125次（55%）相关EMGdi至少为1μV，而舒更葡糖组332次呼吸中有220次（66%）（P = 0.008）。新斯的明后潮气量的中位数（95%CI）为287（256至335）ml，舒更葡糖后为359（313至398）ml（P = 0.013）。拔管后即刻舒更葡糖组PaO2的中位数（95%CI）为30.5（22.8至37.1）kPa，新斯的明组为20.7（12.9至27.5）kPa（P = 0.03）。