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| 不同剂量舒更葡糖钠拮抗卵巢癌新辅助化疗患者神经肌肉阻滞效果的比较 |
| Comparison of effects of different doses of sugammadex in reversing neuromuscular blockade in patients undergoing neoadjuvant chemotherapy for ovarian cancer |
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| DOI：10.12089/jca.2026.02.008 |
| 中文关键词: 舒更葡糖钠 卵巢癌 新辅助化疗 神经肌肉阻滞 罗库溴铵 |
| 英文关键词: Sugammadex Ovarian cancer Neoadjuvant chemotherapy Neuromuscular blockade Rocuronium |
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| 中文摘要: |
目的：比较不同剂量舒更葡糖钠拮抗卵巢癌新辅助化疗患者神经肌肉阻滞的效果。
方法：选择接受新辅助化疗并行卵巢癌根治术患者，年龄18～64岁，ASA Ⅱ或Ⅲ级。将患者随机分为三组：舒更葡糖钠2 mg/kg组（S2组）、舒更葡糖钠3 mg/kg组（S3组）和舒更葡糖钠4 mg/kg组（S4组）。术毕当第2个肌颤搐（T2）重现时，S2、S3、S4组分别给予2、3、4 mg/kg的舒更葡糖钠。主要指标为舒更葡糖钠注射完毕至四个成串刺激（TOF）比值≥0.9的时间。次要指标包括肌松起效时间、临床作用时间、肌松恢复指数、拔管时间、拔管后15 min的Richmond躁动-镇静（RASS）评分、术后住院时间。不良反应包括拔管后呼吸抑制、术后1 d和2 d恶心呕吐发生率。
结果：共纳入患者68例，S2组23例，S3组22例，S4组23例。与S2组比较，S4组舒更葡糖钠注射完毕至TOF比值≥0.9的时间、肌松恢复指数、拔管时间明显缩短（P＜0.05）。与S3组比较，S4组舒更葡糖钠注射完毕至TOF比值≥0.9的时间、拔管时间明显缩短（P＜0.05）。三组肌松起效时间、临床作用时间、拔管后呼吸抑制的发生率、拔管后15 min的RASS评分、术后1 d和2 d恶心呕吐发生率、术后住院时间差异无统计学意义。
结论：对于术前接受新辅助化疗的卵巢癌患者，当T2重现时，舒更葡糖钠4 mg/kg使TOF比值≥0.9的时间及拔管时间显著短于舒更葡糖钠2或3 mg/kg，且其肌松恢复指数也显著优于舒更葡糖钠2 mg/kg。 |
| 英文摘要: |
Objective: To compare the effects of different doses of sugammadex in reversing neuromuscular blockade in patients undergoing neoadjuvant chemotherapy for ovarian cancer.
Methods: Patients aged 18-64 years, ASA physical status Ⅱ or Ⅲ, who underwent neoadjuvant chemotherapy followed by radical surgery for ovarian cancer were enrolled in this study. The patients were randomly divided into three groups: sugammadex 2 mg/kg group (group S2), sugammadex 3 mg/kg group (group S3), and sugammadex 4 mg/kg group (group S4). Upon the reappearance of the second twitch response (T2), sugammadex was administered at doses of 2, 3, and 4 mg/kg in groups S2, S3, and S4, respectively. The primary outcome was the time from sugammadex administration to train-of-four (TOF) ratio ≥ 0.9. Secondary outcomes included onset time of neuromuscular blockade, clinical duration, recovery index, extubation time, the Richmond agitation-sedation scale (RASS) score at 15 minutes after extubation, and postoperative hospital length of stay. Adverse reactiens included post-extubation respiratory depression, postoperative nausea and vomiting on postoperative days 1 and 2.
Results: Sixty-eight patients were ultimately enrolled in this study: 23 patients in group S2, 22 patients in group S3, and 23 patients in group S4. Compared with group S2, the time from sugammadex administration to TOF ratio ≥ 0.9, the recovery index and extubation time were significantly shorter in group S4 (P < 0.05). Compared with group S3, the time from sugammadex administration to TOF ratio ≥ 0.9 and extubation time were significantly shorter in group S4 (P < 0.05). No significant differences were observed among the three groups in terms of onset time, clinical duration, incidence of post-extubation respiratory depression, RASS score 15 minutes after extubation, incidence of postoperative nausea and vomiting on postoperative days 1 and 2, and postoperative hospital length of stay.
Conclusion: For ovarian cancer patients undergoing neoadjuvant chemotherapy, a dose of 4 mg/kg sugammadex administered upon reappearance of T2 significantly shortens the time to TOF ratio ≥ 0.9 and extubation time compared to 2 mg/kg or 3 mg/kg doses. Additionally, the recovery index with sugammadex 4 mg/kg is significantly better than that with 2 mg/kg. |
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