慢性肾病患者使用罗库溴铵与顺阿曲库铵发生急性并发症的风险:倾向匹配研究

IF 4.6 2区 医学 Q1 ANESTHESIOLOGY Anesthesia and analgesia Pub Date : 2024-10-04 DOI:10.1213/ANE.0000000000007188
Nikolas A Georgakis, Sterling J DeShazo, Jonathon I Gomez, Michael P Kinsky, Daniel Arango
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引用次数: 0

摘要

背景:神经肌肉阻滞剂(NMBA)在现代麻醉中发挥着不可或缺的作用,它能促进气管插管、协助机械通气并创造最佳手术条件。然而,NMBAs 可能会产生有害的副作用。本研究旨在回顾性分析两种药效学相似但药代动力学不同的 NMBAs 及其各自逆转剂的急性并发症:方法:使用全球研究网络数据库 TriNetX 评估来自 63 家医疗机构的去身份化患者信息。队列 A 的定义是年龄在 18 至 80 岁之间、患有慢性肾脏病 (CKD) 并接受了罗库溴铵和苏麦得斯治疗的患者。队列 B 的定义是年龄在 18 至 80 岁之间、患有慢性肾脏病并使用顺式库瑞铵加新斯的明的患者。各组群在事件发生时的年龄、民族、种族、性别和相关混杂病症方面进行了倾向匹配。除死亡率外,所有结果均在当天至用药一周后进行分析。死亡率的分析时间则从当天开始到使用索引药物后的 30 天:共有 95,740 名患有慢性阻塞性肺病的患者使用了罗库溴铵和苏格玛司,10,708 名患有慢性阻塞性肺病的患者使用了顺阿曲库铵和新斯的明。使用苏加麦司的罗库溴铵患者发生呼吸衰竭(风险比 [RR],1.98,置信区间 [CI],1.71-2.29,P < .0001)、急性呼吸窘迫(RR,2.70,CI,1.31-5.58,P = .0052)、高血压危象(RR,1.85,CI,1.37-2.49,P < .0001)、心力衰竭(RR,1.14,CI,1.06-1.23,P = .0004)、胸腔积液(RR,1.30,CI,1.14-1.49,P < .0001)和 30 天死亡率(RR,1.31,CI,1.10-1.56,P = .0021):结论:从2003年到2023年,与使用顺阿曲库铵和新斯的明的患者相比,使用罗库溴铵和苏加麦克斯的患者发生急性心血管和肺部并发症的风险明显更高。
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Risk of Acute Complications with Rocuronium versus Cisatracurium in Patients with Chronic Kidney Disease: A Propensity-Matched Study.

Background: Neuromuscular blocking agents (NMBAs) play an integral role in modern anesthesia by facilitating endotracheal tube placement, assisting with mechanical ventilation, and creating optimal surgical conditions. However, NMBAs can have deleterious side effects. The purpose of this study was to retrospectively analyze acute complications of 2 pharmacodynamically similar but pharmacokinetically different NMBAs and their respective reversal agents.

Methods: The global research network database, TriNetX, was used to evaluate deidentified patient information from 63 health care organizations. Cohort A was defined as patients aged 18 to 80 years who had chronic kidney disease (CKD) and were administered rocuronium with sugammadex. Cohort B was defined as patients aged 18 to 80 years who had CKD and were administered cisatracurium with neostigmine. Cohorts were propensity matched for age at event, ethnicity, race, sex, and relevant confounding pathologies. All outcomes besides mortality were analyzed from the same day to 1 week after administration of the indexed drug. Mortality was analyzed from the same day to thirty days after administration of the indexed drug.

Results: A total of 95,740 patients with CKD-administered rocuronium with sugammadex were matched with 10,708 patients with CKD-administered cisatracurium with neostigmine. Patients administered rocuronium with sugammadex had a significantly higher associated risk of respiratory failure (risk ratios [RR], 1.98, confidence interval [CI], 1.71-2.29, P < .0001), acute respiratory distress (RR, 2.70, CI, 1.31-5.58, P = .0052), hypertensive crisis (RR, 1.85, CI, 1.37-2.49, P < .0001), heart failure (RR, 1.14, CI, 1.06-1.23, P = .0004), pleural effusion (RR, 1.30, CI, 1.14-1.49, P < .0001), and 30-day mortality (RR, 1.31, CI, 1.10-1.56, P = .0021).

Conclusions: From 2003 to 2023, patients who were administered rocuronium plus sugammadex were at a significantly higher risk for acute cardiovascular and pulmonary complications when compared to patients who were administered cisatracurium plus neostigmine.

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来源期刊
Anesthesia and analgesia
Anesthesia and analgesia 医学-麻醉学
CiteScore
9.90
自引率
7.00%
发文量
817
审稿时长
2 months
期刊介绍: Anesthesia & Analgesia exists for the benefit of patients under the care of health care professionals engaged in the disciplines broadly related to anesthesiology, perioperative medicine, critical care medicine, and pain medicine. The Journal furthers the care of these patients by reporting the fundamental advances in the science of these clinical disciplines and by documenting the clinical, laboratory, and administrative advances that guide therapy. Anesthesia & Analgesia seeks a balance between definitive clinical and management investigations and outstanding basic scientific reports. The Journal welcomes original manuscripts containing rigorous design and analysis, even if unusual in their approach.
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