Department of Anesthesia, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China.
Drug Des Devel Ther. 2021 Feb 25;15:829-834. doi: 10.2147/DDDT.S286803. eCollection 2021.
Sugammadex has been a revolutionary reversal of neuromuscular blockade. It is known to be highly efficient. However, a change in the coagulation profile is one of the most dangerous potential complications which is a concern for both surgeon and anesthetist. Bleeding may cause hypovolemic shock, hematoma, and so on. To investigate the effects of sugammadex on coagulation profiles in patients with thyroidectomy, we compared patients that were treated with either sugammadex or neostigmine.
Eighty patients with thyroid neoplasms undergoing thyroidectomy were randomly allocated to sugammadex group (group S) or neostigmine group (group N). Induction of anesthesia was preformed using propofol, sufentanil, and rocuronium. Group S received sugammadex 2.0mg/kg after trachea intubation, similarly Group N received neostigmine 40 µg/kg, for reversal of rocuronium-induced neuromuscular blockade. The intraoperative coagulation profiles were monitored after the rocuronium injection (T0), 10 minutes after reversal (T1) and 30 minutes after reversal (T2) by testing activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (FIB), thrombin time (TT), and TEG-Haemonetics. Amount of bleeding was recorded during perioperative period.
There was no significant difference in the thromboelastogram, APTT, PT, FIB, or TT measurements at each time point in Group N. The reaction time (R time) and kinetics time (K time) of Group S in T1 were significantly longer than the corresponding times at T0 and T2, and the R times were significantly longer than those in Group N at the same time points (P<0.05). Additionally, in Group S, the APTT was prolonged in T1 and returned to normal in T2.
The result showed that sugammadex provided transient efficacy in prolonging the coagulation parameters, while neostigmine did not change the coagulation profile.
舒更葡糖钠是一种神经肌肉阻滞逆转的革命性药物。它以高效著称。然而，凝血谱的改变是最危险的潜在并发症之一，这让外科医生和麻醉师都感到担忧。出血可能导致低血容量性休克、血肿等。为了研究舒更葡糖钠对甲状腺切除术患者凝血谱的影响，我们比较了使用舒更葡糖钠或新斯的明治疗的患者。
80 例甲状腺肿瘤患者行甲状腺切除术，随机分为舒更葡糖钠组（S 组）或新斯的明组（N 组）。麻醉诱导采用丙泊酚、舒芬太尼和罗库溴铵。气管插管后 S 组给予舒更葡糖钠 2.0mg/kg，N 组给予新斯的明 40µg/kg 逆转罗库溴铵诱导的神经肌肉阻滞。在罗库溴铵注射后（T0）、逆转后 10 分钟（T1）和 30 分钟（T2）监测术中凝血谱，通过检测激活部分凝血活酶时间（APTT）、凝血酶原时间（PT）、纤维蛋白原（FIB）、凝血酶时间（TT）和血栓弹力图（TEG-Haemonetics）。记录围手术期出血量。
N 组各时间点血栓弹力图、APTT、PT、FIB、TT 测量值无显著差异。S 组 T1 的反应时间（R 时间）和动力学时间（K 时间）明显长于 T0 和 T2 相应时间，R 时间明显长于同时间点 N 组（P<0.05）。此外，S 组 T1 时 APTT 延长，T2 时恢复正常。
结果表明，舒更葡糖钠可短暂延长凝血参数，而新斯的明不改变凝血谱。
