翻译：马艳燕 编辑：佟睿 审校：曹莹
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。
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
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.