舒更葡糖逆转心脏手术患者罗库溴铵的剂量发现研究及复发性肌松的术后监测

本文由“小麻哥的日常”授权转载

摘要译文（供参考）

舒更葡糖逆转心脏手术患者罗库溴铵的剂量发现研究及复发性肌松的术后监测

背景：

当TOF计数为2或以上时，制造商推荐的罗库溴铵拮抗剂舒更葡糖剂量为2 mg/kg，当TOF计数少于2但有至少1时，推荐的剂量为4 mg/kg。 本剂量发现研究的目的是在心脏手术结束时对舒更葡糖剂量进行滴定，使其TOF比率为0.9或更大，并在重症监护室继续监测神经肌肉阻滞，以确定复发性肌松。假设许多患者需要的舒更葡糖剂量低于推荐剂量，但有些患者需要的剂量会更多，并且不会发生复发性肌松。  

方法：  

在心脏手术中应用肌电图监测神经肌肉阻滞。罗库溴铵的给药由麻醉护理团队自行决定。胸骨闭合期间，舒更葡糖每5分钟以50 mg的增量进行滴定，直到获得0.9或更大的TOF比率。在重症监护室用肌电图监测神经肌肉阻滞，直到拔管前停止镇静或最长7小时。  

结果：  

对97例患者进行了评估。达到0.9或更大TOF所需的舒更葡糖剂量在0.43至5.6 mg/kg之间变化。肌松深度与拮抗所需的舒更葡糖剂量之间存在统计学上显著的关系，但在任何肌松深度所需的剂量变化较大。97名患者中有84名（87%）需要低于推荐剂量，13名（13%）需要更多剂量。两名患者因复发性肌松需要额外给予舒更葡糖。  

结论：  

当舒更葡糖被滴定至有效时，剂量通常低于推荐剂量，但在一些患者中更高。因此，定量的肌松监测对于确定舒更葡糖给药后是否发生了充分的逆转至关重要。观察到两名患者出现复发性肌松。  

原文摘要

A Dose-finding Study of Sugammadex for Reversal of Rocuronium in Cardiac Surgery Patients and Postoperative Monitoring for Recurrent Paralysis

Background: The dose of sugammadex recommended by the manufacturer for reversal of rocuronium is 2 mg/kg when the train-of-four count is 2 or more and 4 mg/kg when it is less than 2 but there is a posttetanic count of at least 1. The purpose of this dose-finding study was to titrate sugammadex to produce a train-of-four ratio 0.9 or greater at the conclusion of cardiac surgery, and to continue monitoring neuromuscular blockade in the intensive care unit to identify recurrent paralysis. The hypothesis was that many patients would require less than the recommended dose of sugammadex, but that some would require more, and that recurrent paralysis would not occur. Methods: Neuromuscular blockade was monitored using electromyography during cardiac surgery. Administration of rocuronium was at the discretion of the anesthesia care team. During sternal closure, sugammadex was titrated in 50-mg increments every 5 min until a train-of-four ratio 0.9 or greater was obtained. Neuromuscular blockade was monitored with electromyography in the intensive care unit until sedation was discontinued before extubation or for a maximum of 7 h. Results: Ninety-seven patients were evaluated. The dose of sugammadex required to achieve a train-of-four ratio of 0.9 or greater varied from 0.43 to 5.6 mg/kg. There was a statistically significant relationship between the depth of neuromuscular blockade and the sugammadexdose required for reversal, but there was a large variation in dose required at any depth of neuromuscular blockade. Eighty-four of 97 patients (87%) required less than the recommended dose, and 13 (13%) required more. Two patients required additional sugammadexadministration for recurrent paralysis. Conclusions: When sugammadex was titrated to effect, the dose was usually less than the recommended dose, but it was more in some patients. Therefore, quantitative twitch monitoring is essential for ascertaining that adequate reversal has taken place after sugammadex administration. Recurrent paralysis was observed in two patients. 

编辑：MiSuper.米超

校对：Michel.米萱

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