Zhang Yu, Guo Xiaopeng, Tan Gang, Zhao Mengyun, Huang Yuguang, Chen Wei, Shi Xiaodong, Pei Lijian, Xing Bing
Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng, Beijing 100730, China.
Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng, Beijing 100730, China.
Int J Endocrinol. 2020 Dec 9;2020:2912839. doi: 10.1155/2020/2912839. eCollection 2020.
Tumor resection is the first-line therapy for acromegaly patients. In some cases, unsatisfactory intraoperative neuromuscular blockades (NMBs) lead to failed operations. The purpose of this study was to investigate and quantify the NMB status of acromegaly patients and explore the relationship between NMB status and hormone levels and body composition. Twenty patients with untreated acromegaly and seventeen patients with nonfunctioning pituitary adenomas as controls were enrolled in this study. NMB was assessed using the train-of-four (TOF) technique with TOF-Watch® SX. The onset time of NMB, deep neuromuscular blockade duration (DNMBD), and clinical neuromuscular blockade duration (CNMBD) were monitored. We found a significantly longer onset time (110.25 ± 54.90 vs. 75.00 ± 27.56, s, =0.017), shorter DNMBD (21.99 ± 5.67 vs. 34.96 ± 11.04, min, < 0.001), and shorter CNMBD (33.26 ± 8.09 vs. 46.21 ± 10.89, min, < 0.001) in acromegaly patients compared with the controls. DNMBD and CNMBD decreased in patients with decreasing body fat percentage and increasing growth hormone (GH) level, insulin-like growth factor 1 (IGF-1) level, and GH and IGF-1 burden. The onset time increased with increasing IGF-1 level and GH and IGF-1 burden. Taken together, a unique NMB status was identified in acromegaly patients with the following characteristics: prolonged onset time and shortened DNMBD and CNMBD. Changes in the levels and burdens of GH and IGF-1 and body composition were linearly correlated with intraoperative NMB in acromegaly patients.
肿瘤切除术是肢端肥大症患者的一线治疗方法。在某些情况下，术中神经肌肉阻滞（NMB）效果不理想会导致手术失败。本研究的目的是调查和量化肢端肥大症患者的NMB状态，并探讨NMB状态与激素水平及身体成分之间的关系。本研究纳入了20例未经治疗的肢端肥大症患者和17例无功能性垂体腺瘤患者作为对照。使用TOF-Watch® SX通过四个成串刺激（TOF）技术评估NMB。监测NMB的起效时间、深度神经肌肉阻滞持续时间（DNMBD）和临床神经肌肉阻滞持续时间（CNMBD）。我们发现，与对照组相比，肢端肥大症患者的起效时间显著延长（110.25±54.90 vs. 75.00±27.56，秒，P = 0.017），DNMBD缩短（21.99±5.67 vs. 34.96±11.04，分钟，P < 0.001），CNMBD缩短（33.26±8.09 vs. 46.21±10.89，分钟，P < 0.001）。随着体脂百分比降低以及生长激素（GH）水平、胰岛素样生长因子1（IGF-1）水平以及GH和IGF-1负荷增加，患者的DNMBD和CNMBD降低。起效时间随IGF-1水平以及GH和IGF-1负荷增加而延长。综上所述，在肢端肥大症患者中确定了一种独特的NMB状态，其特征如下：起效时间延长，DNMBD和CNMBD缩短。肢端肥大症患者中GH和IGF-1的水平及负荷以及身体成分的变化与术中NMB呈线性相关。
