Danish Cholinesterase Research Unit, Anaesthesia Critical and Emergency Care Science Unit, Department of Anaesthesiology, Herlev and Gentofte Hospital, Herlev, Copenhagen, Denmark.
Anaesthesia Critical and Emergency Care Science Unit, Department of Anaesthesiology, Herlev and Gentofte Hospital, Herlev, Copenhagen, Denmark.
Anaesthesia. 2019 Apr;74(4):518-528. doi: 10.1111/anae.14545. Epub 2019 Jan 1.
Butyrylcholinesterase deficiency prolongs the effects of the drugs it degrades; succinylcholine and mivacurium. Existing literature on butyrylcholinesterase deficiency is dominated by genetic and biochemical studies. We searched MEDLINE, Embase, Web of Science and Biosis to systematically review the causes and clinical consequences of butyrylcholinesterase deficiency. We considered outcomes clinically relevant if neuromuscular blockade, induced by succinylcholine or mivacurium, was assessed using clinical criteria or neuromuscular monitoring. We included 66 studies: 25 randomised controlled trials; 13 clinically controlled trials; 26 prospective observational studies; 1 retrospective study; and 1 qualitative study. Data heterogeneity precluded quantitative synthesis. Studies described genetic, physiological, acquired or pharmacologically induced causes of butyrylcholinesterase deficiency. The prolongation of neuromuscular blockade by butyrylcholinesterase deficiency was most pronounced with homozygosity of a genetic variant, but other more common factors included increasing age, pregnancy, severe liver disease, burn injuries and drug interactions.
乙酰胆碱酯酶缺乏症延长了它所降解的药物的作用；琥珀酰胆碱和米库氯铵。现有的乙酰胆碱酯酶缺乏症文献主要由遗传和生化研究主导。我们在 MEDLINE、Embase、Web of Science 和 Biosis 中进行了系统检索，以综述乙酰胆碱酯酶缺乏症的病因和临床后果。如果使用临床标准或神经肌肉监测来评估琥珀酰胆碱或米库氯铵引起的神经肌肉阻滞，则我们认为结果具有临床相关性。我们纳入了 66 项研究：25 项随机对照试验；13 项临床对照试验；26 项前瞻性观察性研究；1 项回顾性研究；和 1 项定性研究。数据异质性排除了定量综合分析。研究描述了乙酰胆碱酯酶缺乏症的遗传、生理、获得性或药物诱导原因。乙酰胆碱酯酶缺乏症导致的神经肌肉阻滞延长在遗传变异的纯合子中最为明显，但其他更常见的因素包括年龄增长、妊娠、严重肝脏疾病、烧伤和药物相互作用。
