舒更葡糖钠或新斯的明用于逆转老年患者行电视辅助胸腔镜肺叶切除术后神经肌肉阻滞对术后恢复质量的影响：一项随机对照试验
Sugammadex or neostigmine for reversal of neuromuscular block on the quality of postoperative recovery in elderly adults undergoing video-assisted thoracoscopic lobectomy: a randomised controlled trial.
作者信息
Yang Yu, Wang Zeyang, He Xueqing, Shen Xiaoyun, Jia Wensen, Sheng Xinfang, Yao Xiangyu, Jiao Hao
机构信息
School of Anesthesiology, Xuzhou Medical University, 209 Tongshan Road, Xuzhou, 221004, Jiangsu, China.
Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, No.99 Huaihai West Road, Xuzhou, 221002, Jiangsu, China.
出版信息
BMC Anesthesiol. 2025 May 16;25(1):250. doi: 10.1186/s12871-025-03128-5.
BACKGROUND
Although neostigmine has been traditionally used for neuromuscular blockade reversal in thoracic surgery, incomplete reversal and potential pulmonary complications remain concerns. However, we did not preclude its clinical use. In contrast, sugammadex offers more predictable recovery of neuromuscular function with a superior safety profile. This study aims to compare the efficacy of sugammadex versus neostigmine in improving postoperative recovery outcomes.
METHODS
This study is a prospective, randomized, double-blind trial. Patients above 65 years old undergoing video-assisted thoracoscopic lobectomy were randomly assigned to receive either sugammadex (2 mg/kg) or neostigmine (0.04 mg/kg) with atropine for neuromuscular block reversal after T2 appearance on TOF. The primary outcome was the quality of recovery at postoperative day (POD) 1, assessed by the QoR-15 questionnaire. Secondary outcomes included extubation time, PACU stay, incidence of hypoxaemia, PRNB, and postoperative pulmonary complications (PPCs).
RESULTS
Data analysis included 77 patients (39 in Group S and 38 in Group N). The QoR-15 scores were significantly higher in the sugammadex group at day 1 (125 vs. 122, P < 0.001). Sugammadex significantly reduced extubation time (18 vs. 27.5 min, P = 0.001) and PACU stay (52 vs. 62 min, P = 0.001). Hypoxaemia (28% vs. 53%, P = 0.029) and PRNB (5% vs. 24%, P = 0.020) were less frequent in the sugammadex group. The sugammadex group had fewer PPCs, the difference was not statistically significant (26% vs. 45%, P = 0.079).
CONCLUSIONS
For elderly patients receiving VATS lobectomy, sugammadex is beneficial for acute recovery except PONV up to POD1 recovery quality mainly in ease of breath, eating, resting but not in postoperative outcomes over one month.
TRIAL REGISTRATION
Retrospectively registered, Chinese Clinical Trial Registry, ChiCTR2400089863(Date:18/09/2024).
背景
尽管新斯的明传统上用于胸外科手术中逆转神经肌肉阻滞，但仍存在逆转不完全和潜在肺部并发症的问题。然而，我们并不排除其临床应用。相比之下，舒更葡糖能更可预测地恢复神经肌肉功能，且安全性更高。本研究旨在比较舒更葡糖与新斯的明在改善术后恢复结局方面的疗效。
方法
本研究是一项前瞻性、随机、双盲试验。年龄在65岁以上接受电视辅助胸腔镜肺叶切除术的患者在四个成串刺激（TOF）出现T2后，随机分配接受舒更葡糖（2mg/kg）或新斯的明（0.04mg/kg）加阿托品用于逆转神经肌肉阻滞。主要结局是术后第1天（POD1）的恢复质量，通过QoR-15问卷进行评估。次要结局包括拔管时间、麻醉后恢复室（PACU）停留时间、低氧血症发生率、术后残留神经肌肉阻滞（PRNB）和术后肺部并发症（PPCs）。
结果
数据分析纳入77例患者（舒更葡糖组39例，新斯的明组38例）。舒更葡糖组在第1天的QoR-15评分显著更高（125 vs. 122，P < 0.001）。舒更葡糖显著缩短了拔管时间（18 vs. 27.5分钟，P = 0.001）和PACU停留时间（52 vs. 62分钟，P = 0.001）。舒更葡糖组低氧血症（28% vs. 53%，P = 0.029）和PRNB（5% vs. 24%，P = 0.020）的发生率更低。舒更葡糖组的PPCs更少，差异无统计学意义（26% vs. 45%，P = 0.079）。
结论
对于接受电视辅助胸腔镜肺叶切除术的老年患者，舒更葡糖有利于急性恢复，除了术后恶心呕吐（PONV），直至POD1的恢复质量主要体现在呼吸、进食、休息方面的轻松程度，但对术后一个月以上的结局无影响。
试验注册
回顾性注册，中国临床试验注册中心，ChiCTR2400089863（日期：2024年9月18日）。
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