From the Department of Anaesthesiology, Hospital General Universitario Gregorio Marañón, Madrid (IG), Department of Anaesthesiology, Consorcio Hospital General Universitario de Valencia (CLE), Department of Anaesthesiology, Hospital de Manises, Valencia (GM), Department of Biostatistics, Hospital General Universitario Gregorio Marañón, Madrid (JMB), Department of Anaesthesiology, Hospital Universitari i Politécnic La Fe (OD-C), Perioperative Medicine Research Group Instituto de Investigación Sanitaria La Fe (IIS laFe), Valencia (GM, OD-C) and Pharmacology and Toxicology Department, School of Medicine, Complutense University of Madrid, Madrid, Spain (IG) the Department of Anaesthesiology and Critical Care, Hospital Clinic i Provincial, Barcelona, Spain (CF), CIBER de Enfermedades Respiratorias. Instituto de Salud Carlos III, Madrid, Spain (CF).
Eur J Anaesthesiol. 2020 Mar;37(3):203-211. doi: 10.1097/EJA.0000000000001128.
In intermediate-to-high-risk patients, major abdominal surgery is associated with a high incidence of postoperative complications, mainly pulmonary. Neuromuscular blocking drugs have been suggested as a contributing factor, but this remains unproven.
To define the relationship of neuromuscular blockade management (reversal) with postoperative pulmonary complications (PPCs).
The individualised PeRioperative Open-lung approach Versus standard protectivE ventilation in abdominal surgery study was a prospective, multicentre, four-arm, randomised controlled trial. This is a secondary analysis of the data.
Twenty-one teaching hospitals in Spain. The study was conducted between 2 January 2015, and 18 May 2016.
Age more than 18 years with an intermediate-to-high risk for PPCs, scheduled for major abdominal surgery lasting more than 2 h. Exclusion criteria included pregnancy or breastfeeding, and moderate-to-severe organ diseases.
The mode of reversal of neuromuscular blockade determined two patient groups: pharmacological reversal versus spontaneous recovery.
The primary outcome was a composite of PPCs during the first 30 postoperative days. The association between categorical variables and PPCs within 30 days was studied. Univariate and multivariable logistic regression modelling and propensity score analyses were performed.
From the 923 patients included, 596 (64.6%) presented with PPCs within 30 days after surgery. Patients who developed these complications were older with a higher BMI, a lower pre-operative SpO2, a higher ASA physical status score and a higher incidence of arterial hypertension, diabetes mellitus or chronic obstructive pulmonary disease. Pharmacological neuromuscular blockade reversal was associated with a lower incidence of PPCs (odds ratio 0.62, 95% CI 0.47 to 0.82).
Spontaneous recovery of neuromuscular blockade was an independent risk factor for PPCs in patients with intermediate-to-high risk, undergoing abdominal surgery. We suggest this factor should be included in future studies on PPCs.
clinicaltrials.gov identifier: NCT02158923.
在中高危患者中，大腹部手术与术后并发症（主要是肺部）的发生率较高有关。神经肌肉阻滞剂被认为是一个促成因素，但这尚未得到证实。
确定神经肌肉阻滞管理（逆转）与术后肺部并发症（PPCs）之间的关系。
个体化围手术期开肺治疗与腹部手术中标准保护性通气的比较研究是一项前瞻性、多中心、四臂、随机对照试验。这是对数据的二次分析。
西班牙 21 家教学医院。研究于 2015 年 1 月 2 日至 2016 年 5 月 18 日进行。
年龄大于 18 岁，中高危 PPCs 患者，计划接受超过 2 小时的大腹部手术。排除标准包括妊娠或哺乳，以及中重度器官疾病。
神经肌肉阻滞剂逆转的模式确定了两组患者：药物逆转与自发恢复。
主要结果是术后 30 天内 PPCs 的复合结果。研究了 30 天内分类变量与 PPCs 之间的关系。进行了单变量和多变量逻辑回归模型和倾向评分分析。
从纳入的 923 名患者中，596 名（64.6%）在术后 30 天内出现 PPCs。发生这些并发症的患者年龄较大，BMI 较高，术前 SpO2 较低，ASA 身体状况评分较高，且动脉高血压、糖尿病或慢性阻塞性肺疾病的发生率较高。药物性神经肌肉阻滞剂逆转与 PPCs 发生率降低相关（比值比 0.62，95%置信区间 0.47 至 0.82）。
中高危患者行腹部手术时，神经肌肉阻滞的自发恢复是 PPCs 的独立危险因素。我们建议将该因素纳入未来的 PPCs 研究中。
clinicaltrials.gov 标识符：NCT02158923。
