Du Zhen,Wei Siwei,Xiang Zhen,et al.Comparison of sugammadex versus neostigmine in reducing respiratory complications after extubation in children with adenotonsillectomy[J].Journal of Clinical Pediatric Surgery,2022,21(06):546-550.[doi:10.3760/cma.j.cn101785-202205041-009]
舒更葡糖钠和新斯的明减少腺样体扁桃体切除术儿童拔管后早期呼吸道并发症的对比研究
- Title:
- Comparison of sugammadex versus neostigmine in reducing respiratory complications after extubation in children with adenotonsillectomy
- Keywords:
- Sugammadex; Adenoidectomy; Tonsillectomy; Rocuronium; Airway Obstruction; Hypoxemia
- 摘要:
- 目的 评价舒更葡糖钠降低腺样体扁桃体切除术儿童拔管后早期呼吸道并发症发生率的效果。方法 选择2019年12月至2020年2月湖南省儿童医院行腺样体和（或）扁桃体切除术的患儿90例作为研究对象。采用随机数字表法将90例患儿分为新斯的明组（N组）和舒更葡糖钠组（S组），每组45例。两组均于麻醉诱导后开始监测患儿神经肌肉功能。静脉注射罗库溴铵0.6 mg/kg。术毕，当四个成串刺激（Train-of-Four，TOF） T2出现时，N组注射新斯的明0.02 mg/kg和阿托品0.01 mg/kg；S组注射舒更葡糖钠2 mg/kg。记录神经肌肉阻滞恢复时间、拔管时间和拔管后麻醉恢复室（post anesthesia care unit，PACU）停留时间。观察并记录拔管后早期呼吸道并发症，包括气道梗阻、低氧血症、呼吸暂停、喉痉挛、支气管痉挛、咳嗽和恶心呕吐的发生情况。结果 肌松拮抗后，N组和S组的神经肌肉阻滞恢复时间分别为（2.8±0.7） min和（1.7±0.4） min （P=0.03）。N组拔管时间为（29.5±4.4） min，拔管后PACU停留时间为（9.2±4.0） min。S组拔管时间为（20.1±3.6） min，拔管后PACU停留时间为（5.0±2.2） min。和N组相比，S组拔管时间（P<0.001）和拔管后PACU停留时间（P=0.01）均明显缩短。S组有4例（4/45，8.9%）拔管早期出现气道梗阻，7例（7/45，15.6%）出现低氧血症，1例（1/45，2.2%）出现支气管痉挛；C组拔管早期出现气道梗阻10例（10/45，22.2%），低氧血症16例（16/45，35.6%），支气管痉挛5例（5/45，11.1%），差异均有统计学意义（P均<0.05）。结论 与新斯的明相比，腺样体扁桃体切除术患儿使用舒更葡糖钠拮抗罗库溴铵，不仅能缩短拔管时间和拔管后PACU停留时间，还能降低拔管后早期气道梗阻、低氧血症和支气管痉挛的发生率。
- Abstract:
- Objective To evaluate the effect of sugammadex on reducing the incidence of respiratory complications immediately after extubation in children undergoing adenotonsillectomy.Methods A total of 90 children with adenoidectomy and/or tonsillectomy were randomly divided into neostigmine + atropine group (N) and sugammadex group (S) (n=45 each).Neuromuscular functions were monitored after anesthesia induction.Rocuronium of 0.6 mg/kg was injected intravenously.When T2 of TOF appeared, group N received an injection of 0.02 mg/kg neostigmin+0.01 mg/kg atropine at the end of operation; Group S had sugammadex 2 mg/kg.Neuromuscular block (NMB) recovery time, extubation time and post anesthesia care unit (PACU) retention time were recorded along with respiratory complications of airway obstruction, hypoxemia, apnea, laryngospasm, bronchospasm, cough, nausea and vomiting.Results After muscle relaxation antagonism, recovery time of NMB was longer in group N than that in group S[(2.8±0.7) vs.(1.7±0.4) min, P<0.001].Compared with group N, extubation time[(29.5±4.4) vs.(20.1±3.6) min, P<0.001]and PACU retention time[(9.2±4.0) vs.(5.0±2.2), P=0.01]were significantly shorter in group S.In group S, 4 children (9%) were fewer than 10 children (22%) in group N with airway obstruction immediately after extubation (P=0.03), 7 children (16%) fewer than 16 children (35%) in group N with hypoxemia (P=0.04) and 1 child (2%) fewer than 5 children (11%) in group N with bronchospasm (P=0.04).Conclusion Compared with neostigmine, use of sugammadex for rocuronium antagonism can not only shorten postoperative extubation time and PACU retention time, but also lower the incidence of airway obstruction, hypoxemia and bronchospasm immediately after extubation in children undergoing adenotonsillectomy.
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备注/Memo
收稿日期:2022-02-10。
基金项目:湖南省自然科学基金（S2019JJQNJJ0583）
通讯作者:屈双权,Email:qushuangquan1974@163.com