Sugammadex versus Neostigmine for Reversal of Neuromuscular Blockade and Postoperative Pulmonary Complications (STRONGER): A Multicenter Matched Cohort Analysis.
Sugammadex versus Neostigmine for Reversal of Neuromuscular Blockade and Postoperative Pulmonary Complications (STRONGER): A Multicenter Matched Cohort Analysis.
复制标题
Sugammadex与Neostigmine的神经肌肉阻滞和术后肺并发症的逆转（更强）：多中心匹配的队列分析。
DOI：
10.1097/aln.0000000000003256
复制
发表时间：
2020-06
期刊：
影响因子：
8.8
通讯作者：
Saager L
中科院分区：
文献类型：
--
作者：
Kheterpal S;Vaughn MT;Dubovoy TZ;Shah NJ;Bash LD;Colquhoun DA;Shanks AM;Mathis MR;Soto RG;Bardia A;Bartels K;McCormick PJ;Schonberger RB;Saager L
5%的接受非心脏住院手术的成人患者会出现严重的肺部并发症。我们假设选择肌松拮抗剂（新斯的明与sugammadex）可能与较低的严重肺部并发症发生率相关。2014年1月至2018年8月期间，12家美国多中心围手术期结局组医院被纳入一项多中心观察性匹配队列研究。纳入接受非去极化神经肌肉阻滞剂和逆转的择期住院非心脏外科手术、全麻和气管插管的成人患者。精确匹配标准包括机构、性别、年龄、合并症、肥胖、手术类型和肌松拮抗剂（罗库与维库）。比较其他术前和术中因素，并在残余失衡的情况下进行调整。复合主要结局为术后重大肺部并发症，定义为肺炎、呼吸衰竭或其他肺部并发症（包括肺炎、肺充血、医源性肺栓塞、梗死或气胸）。次要结局集中在肺炎和呼吸衰竭的组成部分。在接受sugammadex治疗的30，026名患者中，22，856名患者与接受新斯的明治疗的22，856名患者匹配。在研究的45，712例患者中，1，892例（4.1%）被诊断为复合主要结局（sugammadex 3.5% vs新斯的明4.8%）。796例（1.7%）患者发生肺炎（1.3% vs 2.2%），582例（1.3%）患者发生呼吸衰竭（0.8% vs 1.7%）。在多变量分析中，sugammadex给药与肺部并发症风险降低30%相关（调整后的比值比0.70，95%置信区间0.63至0.77），肺炎风险降低47%（0.53，0.44 - 0.62），呼吸衰竭风险降低55%（0.45，0.37 - 0.56）。在美国医院接受住院手术的成年患者的一般队列中，使用sugammadex与临床和统计学上显着降低的主要肺部并发症发生率相关。在美国12家医院超过45，000例接受住院非心脏手术的患者中，sugammadex与新斯的明相比，主要肺部并发症的风险降低30%
5% of adult patients undergoing noncardiac inpatient surgery experience a major pulmonary complication. We hypothesized that the choice of neuromuscular blockade reversal (neostigmine versus sugammadex) may be associated with a lower incidence of major pulmonary complications. Twelve US Multicenter Perioperative Outcomes Group hospitals were included in a multicenter observational matched-cohort study of surgical cases between January 2014 and August 2018. Adult patients undergoing elective inpatient non-cardiac surgical procedures with general anesthesia and endotracheal intubation receiving a non-depolarizing neuromuscular blockade agent and reversal were included. Exact matching criteria included institution, sex, age, comorbidities, obesity, surgical procedure type, and neuromuscular blockade reversal agent (rocuronium versus vecuronium). Other preoperative and intraoperative factors were compared and adjusted in the case of residual imbalance. The composite primary outcome was major postoperative pulmonary complications, defined as pneumonia, respiratory failure, or other pulmonary complications (including pneumonitis; pulmonary congestion; iatrogenic pulmonary embolism, infarction, or pneumothorax). Secondary outcomes focused on the components of pneumonia and respiratory failure. Of 30,026 patients receiving sugammadex, 22,856 were matched to 22,856 patients receiving neostigmine. Out of 45,712 patients studied, 1,892 (4.1%) were diagnosed with the composite primary outcome (3.5% sugammadex vs 4.8% neostigmine). 796 (1.7%) patients had pneumonia (1.3% vs 2.2%), and 582 (1.3%) respiratory failure (0.8% vs 1.7%). In multivariable analysis, sugammadex administration was associated with a 30% reduced risk of pulmonary complications (adjusted odds ratio 0.70, 95% confidence interval 0.63 to 0.77), 47% reduced risk of pneumonia (0.53, 0.44 to 0.62), and 55% reduced risk of respiratory failure (0.45, 0.37 to 0.56), compared to neostigmine. Among a generalizable cohort of adult patients undergoing inpatient surgery at US hospitals, the use of sugammadex was associated with a clinically and statistically significant lower incidence of major pulmonary complications. Among more than 45,000 patients undergoing inpatient noncardiac surgery across 12 US hospitals, the administration of sugammadex compared to neostigmine is associated with a 30% lower risk of major pulmonary complications