Department of Anaesthesia and Perioperative Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium.
Department of Anaesthesia and Perioperative Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium; Business Informatics Research Group, University of Ghent, Belgium.
Br J Anaesth. 2020 Oct;125(4):466-482. doi: 10.1016/j.bja.2020.05.063. Epub 2020 Jul 14.
The reported incidence of postoperative residual curarisation (PORC) is still unacceptably high. The capacity of intraoperative neuromuscular monitoring (NMM) to reduce the incidence of PORC has yet to be established from pooled clinical studies. We conducted a meta-analysis of data from 1979 to 2019 to reanalyse this relationship.
English language, peer-reviewed, and operation room adult anaesthesia setting articles published between 1979 and 2019 were searched for on PubMed, Cochrane Central Register of Controlled Trials, ISI-WoK, and Scopus. The primary outcome was PORC incidence as defined by an at- or post-extubation train-of-four ratio (TOFR) of lower than 0.7, 0.9, or 1.0. Additional collected variables included the duration of action of neuromuscular blocking agents (NMBAs) used, sugammadex or neostigmine use, and the technique of anaesthesia maintenance.
Fifty-three studies (109 study arms, 12 664 patients) were included. The pooled PORC incidence associated with the use of intermediate duration NMBAs and quantitative NMM was 0.115 (95% confidence interval [CI], 0.057-0.188). This was significantly lower than the PORC rate for both qualitative NMM (0.306; 95% CI, 0.09-0.411) and no NMM (0.331; 95% CI, 0.234-0.435). Anaesthesia type did not significantly affect PORC incidence. Sugammadex use was associated with lower PORC rates. The GRADE global level of evidence was very low and the refined assessment of the network meta-analysis by means of a confidence in network meta-analysis raised concerns on within- and across-study bias.
Quantitative NMM outperforms both subjective and no NMM monitoring in reducing PORC as defined by a TOFR of <0.9.
术后残余肌松（PORC）的报告发生率仍然高得令人无法接受。术中神经肌肉监测（NMM）降低 PORC 发生率的能力尚未通过汇总的临床研究得到证实。我们对 1979 年至 2019 年的数据进行了荟萃分析，以重新分析这种关系。
在 1979 年至 2019 年间，在 PubMed、Cochrane 对照试验中心注册、ISI-WoK 和 Scopus 上搜索了英语同行评审和手术室成人麻醉环境的文章。主要结果是根据拔管后或拔管后四个成串刺激（TOFR）比低于 0.7、0.9 或 1.0 定义的 PORC 发生率。收集的其他变量包括使用的神经肌肉阻滞剂（NMBA）的作用持续时间、舒更葡糖或新斯的明的使用以及麻醉维持技术。
纳入 53 项研究（109 个研究臂，12664 例患者）。使用中效持续时间的 NMBA 和定量 NMM 与 PORC 发生率为 0.115（95%置信区间 [CI]，0.057-0.188）相关。这明显低于定性 NMM（0.306；95%CI，0.09-0.411）和无 NMM（0.331；95%CI，0.234-0.435）的 PORC 率。麻醉类型对 PORC 发生率没有显著影响。舒更葡糖的使用与 PORC 发生率降低相关。GRADE 全球证据水平非常低，通过置信网络荟萃分析对网络荟萃分析的精细评估引起了对研究内和研究间偏倚的关注。
定量 NMM 在降低 PORC 方面优于主观和无 NMM 监测，PORC 定义为 TOFR<0.9。
