深肌松对老年全髋关节置换术后患者血清细胞因子及术后谵妄的影响：一项前瞻性单盲随机对照试验。

Effect of deep neuromuscular blockade on serum cytokines and postoperative delirium in elderly patients undergoing total hip replacement: A prospective single-blind randomised controlled trial.

机构信息

From the Department of Anaesthesiology and Pain Medicine (C-SO, HYL, S-HK), Department of Psychiatry (HJJ), Department of Orthopaedic surgery, Konkuk University Medical Centre (T-HK), Department of Infection and Immunology (H-JP, LP, S-HK), Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea (C-SO, S-HK).

出版信息

Eur J Anaesthesiol. 2021 Mar 1;38(Suppl 1):S58-S66. doi: 10.1097/EJA.0000000000001414.

DOI:10.1097/EJA.0000000000001414

PMID:33399376

Abstract

BACKGROUND

Deep neuromuscular blockade (NMB) may reduce muscle injury and related inflammation. The inflammation is one of the pathophysiological processes of peri-operative complications.

OBJECTIVE

To compare the degree of inflammation and related postoperative complications including postoperative delirium (POD) and peri-operative bleeding according to the degree of NMB during general anaesthesia for total hip replacement.

DESIGN

A prospective, single-blind, randomised controlled trial.

SETTING

Tertiary, university hospital, single centre.

PATIENTS

Eighty-two patients undergoing total hip replacement surgery were included in the final analysis.

INTERVENTIONS

Moderate (Mod) and deep (Deep) NMB groups.

MAIN OUTCOME MEASURES

The changes in inflammatory cytokines were measured. The incidence of POD was evaluated by using confusion assessment method (CAM). The differences of postoperative bleeding and peri-operative oxygenation in both groups were also measured.

RESULTS

The NMB reversal duration was significantly longer in the Mod NMB group than in the Deep NMB group. Changes in interleukin-6 were significantly smaller in the Deep NMB group than in the Mod NMB group (P < 0.001). The incidence of POD was not significantly different between groups (34 versus 17% in Mod and Deep NMB groups, respectively; P = 0.129). The amount of postoperative bleeding until postoperative day 2 was significantly greater in the Mod NMB group than in the Deep NMB group (P = 0.027).

CONCLUSION

Our findings suggest that inflammation related to peri-operative complications could be associated with the depth of NMB during total hip replacement. However, the incidence of POD might not be associated to the depth of NMB.

TRIAL REGISTRATION

National Library of Medicine (NLM) at the National Institutes of Health (NIH) of United States. (Identifier: NCT02507609). Online address: http://clinicaltrials.gov.

摘要

背景

深度神经肌肉阻滞（NMB）可能会减少肌肉损伤和相关炎症。炎症是围手术期并发症的病理生理过程之一。

目的

比较全身麻醉下全髋关节置换术时不同程度 NMB 对炎症程度和相关术后并发症（包括术后谵妄（POD）和围手术期出血）的影响。

设计

前瞻性、单盲、随机对照试验。

设置

三级、大学医院、单中心。

患者

共 82 例接受全髋关节置换术的患者纳入最终分析。

干预措施

中度（Mod）和深度（Deep）NMB 组。

主要观察指标

炎症细胞因子的变化。采用意识模糊评估法（CAM）评估 POD 的发生率。比较两组患者术后出血量和围术期氧合的差异。

结果

Mod NMB 组的 NMB 逆转时间明显长于 Deep NMB 组。Deep NMB 组白细胞介素-6 的变化明显小于 Mod NMB 组（P<0.001）。两组 POD 的发生率无显著差异（Mod 和 Deep NMB 组分别为 34%和 17%；P=0.129）。Mod NMB 组术后 2 天内的出血量明显大于 Deep NMB 组（P=0.027）。