【罂粟摘要】大剂量肌松药对婴幼儿术后呼吸并发症的影响
大剂量肌松药对婴幼儿术后呼吸并发症的影响
贵州医科大学 麻醉与心脏电生理课题组
翻译：马艳燕 编辑：佟睿 审校：曹莹
本研究评估了肌松药剂量与婴幼儿手术后呼吸道并发症之间的关系。
对6507例0~10岁手术患儿的全身麻醉药资料进行分析，观察肌松药剂量对术后呼吸并发症(主要结局指标)和次要结局指标的影响。混杂因素校正分析包括年龄、手术持续时间和全身状况。
在混杂因素校正分析中，高剂量肌松药导致术后呼吸并发症的风险更高 (OR 2.27；95%CI 1.12-4.59；P=0.022)。这种影响随着年龄的不同而改变(P=0.016)，在婴幼儿小于等于一岁时风险更大（OR 3.84;95% CI 1.35‐10.94; P=0.012)；这种影响随着手术持续时间的改变而改变(P = 0.006)，手术持续时间小于90分钟的影响几率较大(OR 4.25; 95% CI 1.19‐15.18; P=0.026)；这种影响随着不同ASA分级而改变(P=0.015)，随着病人手术风险的增加而增加(ASA >1: OR 3.17; 95% CI 1.43‐7.04; P=0.005)。新斯的明逆转并没有改变肌松药和手术后呼吸并发症之间的关系(P=0.38)。工具变量分析证实，大剂量肌松药与术后呼吸并发症有关，这证明了关于未观察到的混杂问题的可靠结果。
大剂量的肌松药与术后呼吸并发症有关。我们已经确定了婴儿、接受短程手术的儿科患者、以及ASA分级较高的患者，他们特别容易受神经肌肉阻滞药呼吸道副作用的影响。
Scheffenbichler FT, Rudolph MI, Friedrich S, et al. Effects of high neuromuscular blocking agent dose on post-operative respiratory complications in infants and children. Acta Anaesthesiol Scand. 2020 Feb;64(2):156-167.
Effects of high neuromuscular blocking agent dose on post‐operative respiratory complications in infants and children
Abstract
Background: This study evaluated the association between neuromuscular blocking agent dose and post‐operative respiratory complications in infants and children.
Methods: Data from 6507 general anaesthetics provided to children aged 0‐10 years undergoing surgery were analysed to examine the effects of neuromuscular blocking agent dose on post‐operative respiratory complications (primary endpoint) and secondary endpoints. Confounder‐adjusted analyses addressed age, surgical duration, and comorbidity burden.
Results: In confounder‐adjusted analyses, high doses of neuromuscular blocking agents were associated with higher risk of post‐operative respiratory complications (OR 2.27; 95% CI 1.12‐4.59; P=. 022). The effect was modified by age (P‐for‐inter‐action=.016) towards a more substantial risk in infants ≤1 year (OR 3.84; 95% CI 1.35‐10.94; P=.012), by duration of surgery (P‐for‐interaction = .006) towards a higher difference in odds for surgeries <90 minutes (OR 4.25; 95% CI 1.19‐15.18; P = .026), and by ASA physical status (P‐for‐interaction = .015) with a greater effect among patients with higher operative risk (ASA >1: OR 3.17; 95% CI 1.43‐7.04; P =.005). Neostigmine reversal did not modify the association between neuromuscular blocking agents and post‐operative respiratory complications (P‐for‐interaction=.38). Instrumental variable analysis confirmed that high doses of neuromuscular blocking agents were associated with post‐operative respiratory complications (probit coefficient 0.25; 95% CI 0.04‐0.46; P = .022), demonstrating robust results regarding concerns of unobserved confounding.
Conclusion: High dose of neuromuscular blocking agents is associated with post‐operative respiratory complications. We have identified subcohorts of paediatric patients who are particularly vulnerable to the respiratory side‐effects of neuromuscular blocking agents: infants, paediatric patients undergoing surgeries of short duration, and those with a high ASA risk score.