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罗库溴铵院外快速顺序气管插管成功率低于琥珀胆碱
作者:小柯机器人 发布时间:2019/12/20 13:27:55

法国留尼汪大学Xavier Combes联合圣丹尼急诊科Bertrand Guihard课题组的一项最新研究,探讨了罗库溴铵与琥珀胆碱对院外快速顺序气管插管成功率的影响。2019年12月17日,国际知名学术期刊《美国医学会杂志》发表了这一成果。

罗库溴铵和琥珀胆碱常用于快速顺序气管插管,但这些麻痹剂在紧急情况下插管的成功率尚未在临床试验中评估。琥珀胆碱常导致一些不良反应,而罗库溴铵则相对安全。

2014年1月至2016年8月,研究组在法国的17家医院进行了一项多中心、单盲、非劣效性、随机临床试验,共招募了1248例需行院外气管插管的患者,平均年龄56岁,女性占40.1%。将其随机分组,其中624例采用罗库溴铵,624例采用琥珀胆碱,均行快速顺序气管插管。

1226例患者纳入最终分析。罗库溴铵组的首次插管成功率为74.6%,低于琥珀胆碱组的79.4%,不符合非劣效性标准。最常见的插管相关不良事件为低氧血症和低血压,其中罗库溴铵组中的发生率分别为9.0%和6.4%,琥珀胆碱组中分别为9.9%和10.1%。

综上,在院外紧急情况下行气管插管的患者中,采用罗库溴铵的首次插管成功率低于琥珀胆碱。

附:英文原文

Title: Effect of Rocuronium vs Succinylcholine on Endotracheal Intubation Success Rate Among Patients Undergoing Out-of-Hospital Rapid Sequence Intubation: A Randomized Clinical Trial

Author: Bertrand Guihard, Charlotte Chollet-Xémard, Philippe Lakhnati, Benoit Vivien, Claire Broche, Dominique Savary, Agnes Ricard-Hibon, Pierre-Jean Marianne dit Cassou, Frédéric Adnet, Eric Wiel, Juliette Deutsch, Cindy Tissier, Thomas Loeb, Vincent Bounes, Emmanuel Rousseau, Patricia Jabre, Laetitia Huiart, Cyril Ferdynus, Xavier Combes

Issue&Volume: 2019/12/17

Abstract:

Importance  Rocuronium and succinylcholine are often used for rapid sequence intubation, although the comparative efficacy of these paralytic agents for achieving successful intubation in an emergency setting has not been evaluated in clinical trials. Succinylcholine use has been associated with several adverse events not reported with rocuronium.

Objective  To assess the noninferiority of rocuronium vs succinylcholine for tracheal intubation in out-of-hospital emergency situations.

Design, Setting and Participants  Multicenter, single-blind, noninferiority randomized clinical trial comparing rocuronium (1.2 mg/kg) with succinylcholine (1 mg/kg) for rapid sequence intubation in 1248 adult patients needing out-of-hospital tracheal intubation. Enrollment occurred from January 2014 to August 2016 in 17 French out-of-hospital emergency medical units. The date of final follow-up was August 31, 2016.

Interventions  Patients were randomly assigned to undergo tracheal intubation facilitated by rocuronium (n = 624) or succinylcholine (n = 624).

Main Outcomes and Measures  The primary outcome was the intubation success rate on first attempt. A noninferiority margin of 7% was chosen. A per-protocol analysis was prespecified as the primary analysis.

Results  Among 1248 patients who were randomized (mean age, 56 years; 501 [40.1%] women), 1230 (98.6%) completed the trial and 1226 (98.2%) were included in the per-protocol analysis. The number of patients with successful first-attempt intubation was 455 of 610 (74.6%) in the rocuronium group vs 489 of 616 (79.4%) in the succinylcholine group, with a between-group difference of −4.8% (1-sided 97.5% CI, −9% to ∞), which did not meet criteria for noninferiority. The most common intubation-related adverse events were hypoxemia (55 of 610 patients [9.0%]) and hypotension (39 of 610 patients [6.4%]) in the rocuronium group and hypoxemia (61 of 616 [9.9%]) and hypotension (62 of 616 patients [10.1%]) in the succinylcholine group.

Conclusions and Relevance  Among patients undergoing endotracheal intubation in an out-of-hospital emergency setting, rocuronium, compared with succinylcholine, failed to demonstrate noninferiority with regard to first-attempt intubation success rate.

DOI: 10.1001/jama.2019.18254

Source: https://jamanetwork.com/journals/jama/article-abstract/2757578

期刊信息

JAMA-Journal of The American Medical Association:《美国医学会杂志》,创刊于1883年。隶属于美国医学协会,最新IF:51.273
官方网址:https://jamanetwork.com/
投稿链接:http://manuscripts.jama.com/cgi-bin/main.plex