颅神经损伤是颈淋巴结清扫术的一种罕见但重要的并发症。我们检查了术中神经肌肉阻滞的使用与颈清扫术中医源性颅神经损伤之间的关系。
这是一个单一的中心,回顾性,电子健康记录审查。研究纳入标准规定患者>18岁,在全身麻醉下解剖颈部淋巴水平≥2个恶性肿瘤,手术日期在2008年至2018年之间。在颈清扫术中使用神经肌肉阻滞是主要的自变量。这被定义为任何使用罗库溴铵,顺式阿曲库铵,麻醉诱导后或维库溴铵,在手术切口前没有用sugammadex逆转。单变量测试用于比较那些患者之间的变量,和那些没有,医源性脑神经损伤.多变量逻辑回归确定了颅神经损伤的预测因子,并结合Firth的估计进行,因为主要结局的患病率较低。
我们的队列包括对897例患者进行的925种不同的颈淋巴结清扫术。在285(30.8%)颈淋巴结清扫术中使用了神经肌肉阻滞。确定了14例(占手术病例的1.5%)神经损伤。在单变量逻辑回归中,使用神经肌肉阻滞与医源性颅神经损伤无关(OR:1.73,95%CI:0.62-4.86,p=0.30).在多变量逻辑回归控制患者年龄方面没有显著关联,性别,体重,ASA类,麻痹剂量,糖尿病史,中风,冠状动脉疾病,颈动脉粥样硬化,心肌梗塞,和心律失常(OR:1.87,95%CI:0.63-5.51,p=0.26)。
在这项研究中,颈淋巴清扫术中使用神经肌肉阻滞与医源性颅神经损伤的发生率无关.虽然这项调查提供了早期支持的安全使用神经肌肉阻滞在颈部解剖,未来有更大权力的调查仍然是必要的。
Cranial nerve injury is an uncommon but significant complication of neck dissection. We examined the association between the use of intraoperative neuromuscular blockade and iatrogenic cranial nerve injury during neck dissection.
This was a single-center, retrospective, electronic health record review. Study inclusion criteria stipulated patients > 18 years who had ≥ 2 neck lymphatic levels dissected for malignancy under general anesthesia with a surgery date between 2008 - 2018. Use of neuromuscular blockade during neck dissection was the primary independent variable. This was defined as any use of rocuronium, cisatracurium, or vecuronium upon anesthesia induction without reversal with sugammadex prior to surgical incision. Univariate tests were used to compare variables between those patients with, and those without, iatrogenic cranial nerve injury. Multivariable logistic regression determined predictors of cranial nerve injury and was performed incorporating Firth\'s estimation given low prevalence of the primary outcome.
Our cohort consisted of 925 distinct neck dissections performed in 897 patients. Neuromuscular blockade was used during 285 (30.8%) neck dissections. Fourteen instances (1.5% of surgical cases) of nerve injury were identified. On univariate logistic regression, use of neuromuscular blockade was not associated with iatrogenic cranial nerve injury (OR: 1.73, 95% CI: 0.62 - 4.86, p = 0.30). There remained no significant association on multivariable logistic regression controlling for patient age, sex, weight, ASA class, paralytic dose, history of diabetes, stroke, coronary artery disease, carotid atherosclerosis, myocardial infarction, and cardiac arrythmia (OR: 1.87, 95% CI: 0.63 - 5.51, p = 0.26).
In this study, use of neuromuscular blockade intraoperatively during neck dissection was not associated with increased rates of iatrogenic cranial nerve injury. While this investigation provides early support for safe use of neuromuscular blockade during neck dissection, future investigation with greater power remains necessary.