目的:围手术期神经肌肉阻滞剂在药理学上被逆转,以减少与残余神经肌肉阻滞相关的并发症。抗胆碱酯酶的神经肌肉阻滞逆转(例如,新斯的明)需要共同施用抗胆碱能药(例如,格隆溴铵)减轻毒蕈碱活性;然而,sugammadex,缺乏胆碱能活性,不需要抗胆碱能联合给药。单机构研究发现,与sugammadex逆转相关的术后尿潴留发生率降低。这项研究使用了多中心数据库,以更好地了解神经肌肉阻滞逆转技术与术后尿潴留之间的关系。
方法:利用大型医疗保健数据库进行回顾性队列研究。
方法:非营利组织,农村和城市地区的非政府和社区以及教学医院和卫生系统。
方法:61,898名匹配的成人住院患者和95,500名匹配的成人门诊患者。
方法:用Sugamadex或新斯的明加格隆溴铵逆转神经肌肉阻滞。
方法:神经肌肉阻滞逆转剂术后尿潴留的发生率以及神经肌肉阻滞逆转技术与术后尿潴留风险的独立关联。
结果:与Sugamadex患者相比,新斯的明与格隆溴铵的术后尿潴留发生率高2倍(5.0%vs2.4%;0.9%vs0.4%门诊患者;两者均p<0.0001)。多变量逻辑回归确定,新斯的明逆转与术后尿潴留的更大风险独立相关(住院患者:比值比,2.20;95%置信区间,2.00至2.41;p<0.001;门诊患者:比值比,2.57;95%置信区间,2.13至3.10;p<0.001)。出院后2天内与尿retention留相关的访视在新斯的明逆转者中比住院患者中的sugammadex高出五倍(0.05%vs.0.01%,分别为;p=0.018)和门诊患者(0.5%与0.1%;p<0.0001)。
结论:虽然本研究提示新斯的明逆转神经肌肉阻滞可增加术后尿潴留风险,需要更多的研究来充分了解这种关联.
Perioperative neuromuscular blocking agents are pharmacologically reversed to minimize complications associated with residual neuromuscular block. Neuromuscular block reversal with anticholinesterases (e.g., neostigmine) require coadministration of an anticholinergic agent (e.g., glycopyrrolate) to mitigate muscarinic activity; however, sugammadex, devoid of cholinergic activity, does not require anticholinergic coadministration. Single-institution studies have found decreased incidence of post-operative urinary retention associated with sugammadex reversal. This
study used a multicenter database to better understand the association between neuromuscular block reversal technique and post-operative urinary retention.
Retrospective cohort
study utilizing large healthcare database.
Non-profit, non-governmental and community and teaching hospitals and health systems from rural and urban areas.
61,898 matched adult inpatients and 95,500 matched adult outpatients.
Neuromuscular block reversal with sugammadex or neostigmine plus glycopyrrolate.
Incidence of post-operative urinary retention by neuromuscular block reversal agent and the independent association of neuromuscular block reversal technique and risk of post-operative urinary retention.
The incidence of post-operative urinary retention was 2-fold greater among neostigmine with glycopyrrolate compared to sugammadex patients (5.0% vs 2.4% inpatients; 0.9% vs 0.4% outpatients; both p < 0.0001). Multivariable logistic regression identified reversal with neostigmine to be independently associated with greater risk of post-operative urinary retention (inpatients: odds ratio, 2.20; 95% confidence interval, 2.00 to 2.41; p < 0.001; outpatients: odds ratio, 2.57; 95% confidence interval, 2.13 to 3.10; p < 0.001). Post-operative urinary retention-related visits within 2 days following discharge were five-fold higher among those reversed with neostigmine than sugammadex among inpatients (0.05% vs. 0.01%, respectively; p = 0.018) and outpatients (0.5% vs. 0.1%; p < 0.0001).
Though this
study suggests that neuromuscular block reversal with neostigmine can increase post-operative urinary retention risk, additional studies are needed to fully understand the association.