氯化钙联合新斯的明对神经肌肉阻滞恢复的影响：一项双盲随机研究。

Effects of calcium chloride coadministered with neostigmine on neuromuscular blockade recovery: A double-blind randomised study.

机构信息

From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul (J-WJ, SY, DMH, H-PP), Keimyung University Dongsan Medical Center, Daegu (H-CK), South Korea.

出版信息

Eur J Anaesthesiol. 2017 Sep;34(9):617-622. doi: 10.1097/EJA.0000000000000649.

DOI:10.1097/EJA.0000000000000649

PMID:28763316

Abstract

BACKGROUND

Ionised calcium plays an important role in neuromuscular transmission, but its effects on the reversal of nondepolarising neuromuscular blockade have not been fully evaluated.

OBJECTIVE

We examined whether calcium chloride coadministered with neostigmine could enhance the rate of neuromuscular recovery.

DESIGN

Randomised double-blind trial.

SETTING

A tertiary teaching hospital.

PATIENTS

In total, 53 patients undergoing elective surgery under general anaesthesia with neuromuscular monitoring by acceleromyography using a TOF-Watch SX monitor.

INTERVENTIONS

Patients were randomly allocated to receive either 5 mg kg of calcium chloride (calcium group, n = 26) or the same volume of normal saline (control group, n = 27) coadministered with 25 μg kg of neostigmine and 15 μg kg of atropine at the end of surgery.

MAIN OUTCOME MEASURES

The primary end point was the neuromuscular recovery time [time from neostigmine administration to recovery of the TOF ratio (TOFr) to 0.9]. Secondary end points included the TOFr at 5, 10 and 20 min after neostigmine administration and the incidence of postoperative residual curarisation (PORC), defined as a TOFr less than 0.9 at each time point.

RESULTS

The neuromuscular recovery time was significantly faster in the calcium group than in the control group (median [Q1 to Q3]; 5.0 [3.0 to 7.0] vs. 6.7 [5.7 to 10.0] min, respectively; P = 0.007). At 5 min after neostigmine administration, the TOFr was higher [87 (74 to 100) vs. 68 (51 to 81)%, respectively; P = 0.002] and the incidence of PORC was lower (50.0 vs. 81.5%, respectively; P = 0.016) in the calcium group than in the control group. There were no differences between the two groups with respect to the TOFr or incidence of PORC at 10 and 20 min after neostigmine administration.

CONCLUSION

Calcium chloride coadministered with neostigmine enhanced neuromuscular recovery in the early period of nondepolarising neuromuscular blockade reversal.

摘要

背景

离子钙在神经肌肉传递中发挥重要作用，但它对非去极化神经肌肉阻滞逆转的影响尚未得到充分评估。

目的

我们研究了氯化钙与新斯的明联合使用是否能加快神经肌肉恢复的速度。

设计

随机双盲试验。

地点

一家三级教学医院。

患者

总共 53 名接受全身麻醉下择期手术的患者，使用 TOF-Watch SX 监测仪通过加速肌描记法进行神经肌肉监测。

干预措施

患者随机分配接受 5mg/kg 的氯化钙（钙组，n=26）或相同体积的生理盐水（对照组，n=27），与新斯的明 25μg/kg 和阿托品 15μg/kg 一起在手术结束时给予。

主要观察指标

主要终点是神经肌肉恢复时间[从新斯的明给药到 TOF 比（TOFr）恢复到 0.9 的时间]。次要终点包括新斯的明给药后 5、10 和 20 分钟时的 TOFr，以及术后残余肌松（PORC）的发生率，定义为每个时间点的 TOFr 小于 0.9。

结果

钙组的神经肌肉恢复时间明显快于对照组（中位数[Q1 到 Q3]；5.0[3.0 到 7.0]比 6.7[5.7 到 10.0]分钟，P=0.007）。新斯的明给药后 5 分钟时，TOFr 更高[87（74 到 100）比 68（51 到 81）%，P=0.002]，钙组 PORC 的发生率更低（50.0 比 81.5%，P=0.016）。新斯的明给药后 10 和 20 分钟时，两组间 TOFr 或 PORC 的发生率无差异。