【罂粟摘要】舒更葡糖与新斯的明对甲状腺切除术患者术中凝血功能的影响
中文摘要 舒更葡糖与新斯的明对甲状腺切除术患者术中凝血功能的影响 贵州医科大学 高鸿教授课题组 翻译：吴学艳 编辑：佟睿 审校：曹莹 01 舒更葡糖是神经肌肉阻滞剂的革命性逆转，以其高效的拮抗作用著称；然而，凝血功能的改变是最危险的潜在并发症之一，是外科医生和麻醉医生共同关注的问题。出血可能导致低血容量性休克、血肿等。为了研究舒更葡糖对甲状腺切除术患者术中凝血功能的影响，将使用舒更葡糖或新斯的明进行治疗的患者进行比较。 将80例甲状腺肿瘤患者随机分为舒更葡糖组(S组)和新斯的明组(N组)；麻醉诱导使用异丙酚、舒芬太尼和罗库溴铵。气管插管后S组给予舒更葡糖2.0 mg/kg，N组给予新斯的明40µg/kg，以逆转罗库溴铵所致的神经肌肉阻滞作用。分别于注射罗库溴铵后(T0)、逆转后10min(T1)、逆转后30min(T2)检测活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、凝血酶时间(TT)和TEG血液学指标，并记录围手术期出血量。 N组各时间点的血栓弹性图、APTT、PT、FIB、TT无明显差异，T1组的反应时间(R时间)和动力学时间(K时间)明显长于T0、T2相应时间，R时间明显长于N组相同时间点的R时间(P<0.05)。S组在T1时APTT延长，T2时恢复正常。 舒更葡糖具有短暂的延长凝血指标作用，而新斯的明对凝血功能无明显影响。 Effects of Sugammadex versus Neostigmine on Intraoperative Coagulation Profiles in Patients with Thyroidectomy Abstract Background: 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. Patients and Methods: 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. Results: 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. Conclusion: The result showed that sugammadex provided transient efficacy in prolonging the coagulation parameters, while neostigmine did not change the coagulation profile.