TOF值恢复时低剂量Sugammadex对神经肌肉阻滞剂维库溴铵的拮抗作用
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Reversal of Vecuronium-induced Neuromuscular Blockade with Low-dose Sugammadex at Train-of-four Count of Four
背景与目的
在罗库溴铵诱导的神经肌肉阻滞中，TOF值恢复时，0.5mg/kg或1.0mg/kg的Sugammadex可完全逆转其肌松残余作用。由于维库溴铵的药理特性，同样剂量的Sugammadex是否可完全逆转相同肌松状态下的维库溴铵残余作用尚不确定。
方 法
本研究为单中心、随机对照研究。纳入65例择期手术患者，最终64例患者完成所有研究内容。随机分为五个组，分别为Sugammadex0.5、1.0或2.0mg/kg组、新斯的明0.05mg/kg组以及安慰剂组。所有患者接受（丙泊酚+七氟烷+芬太尼+维库溴铵）进行全身麻醉。主要观察指标为从药物注射至肌松恢复至TOF值0.9的时间及拮抗效率和30min内没有完全拮抗的发生率。次要观察指标为拮抗后第一个60min内出现再阻滞（TOF比值<0.9）的发生率。
结 果
静脉注射Sugammadex1.0mg/kg和2.0mg/kg后，恢复至TOF值≥0.9所需要的时间分别为4.4± 2.3 min和2.6 ± 1.6 min，拮抗不完全（ TOF比值<0.9）者为0；Sugammadex0.5 mg/kg组，恢复至TOF值≥0.9所需要的时间为6.8±4.1min，拮抗不完全者为4例，与其他两组比较有显著差异性(P值均< 0.0001)；新斯旳明组逆转时间为11.3±9.7min，显著长于Sugammadex1.0mg/kg组和2.0mg/kg组(P< 0.05)，但与Sugammadex0.5mg/kg组比较无显著差异，拮抗不全者3例。安慰剂组肌松拮抗恢复不全者为13例
结 论
与0.5mg/kg Sugammadex不同的是，当TOF出现四个成串刺激反应时，1.0 mg/kg剂量的Sugammadex可完全拮抗维库溴铵的残余作用，但并不能完全避免术后阻滞作用的发生。
原始文献摘要
Asztalos L, SzabóMaák Z, Gajdos A, et al. Reversal of Vecuronium-induced Neuromuscular Blockade with Low-dose Sugammadex at Train-of-four Count of Four: A Randomized Controlled Trial.[J]. Anesthesiology, 2017.
Background: Rocuronium-induced neuromuscular block that spontaneously recovered to a train-of-four count of four can be reversed with sugammadex 0.5 or 1.0 mg/kg. We investigated whether these doses of sugammadex can also reverse vecuronium at a similar level of block.
Methods: Sixty-five patients were randomly assigned, and 64 were analyzed in this controlled, superiority study. Participants received general anesthesia with propofol, sevoflurane, fentanyl, and vecuronium. Measurement of neuromuscular function was performed with acceleromyography (TOF-Watch-SX, Organon Teknika B.V., The Netherlands ). Once the block recovered spontaneously to four twitches in response to train-of-four stimulation, patients were randomly assigned to receive sugammadex 0.5, 1.0, or 2.0 mg/kg; neostigmine 0.05 mg/kg; or placebo. Time from study drug injection to normalized
train-of-four ratio 0.9 and the incidence of incomplete reversal within 30 min were the primary outcome variables. Secondary outcome was the incidence of reparalysis (normalized train-of-four ratio less than 0.9).
Results: Sugammadex, in doses of 1.0 and 2.0 mg/kg, reversed a threshold train-of-four count of four to normalized train-offour ratio of 0.9 or higher in all patients in 4.4 ± 2.3 min (mean ± SD) and 2.6 ± 1.6 min, respectively. Sugammadex 0.5 mg/kg
reversed the block in 6.8 ± 4.1 min in 70% of patients (P < 0.0001 vs. 1.0 and 2.0 mg/kg), whereas neostigmine produced reversal in 11.3 ± 9.7 min in 77% of patients (P > 0.05 vs. sugammadex 0.5 mg/kg). The overall frequency of reparalysis was 18.7%, but this incidence varied from group to group.
Conclusions: Sugammadex 1.0 mg/kg, unlike 0.5 mg/kg, properly reversed a threshold train-of-four count of four vecuroniuminduced block but did not prevent reparalysis.
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