Sugammadex和新斯的明对氨基甾体类肌松药肌松拮抗效果及安全性的系统评价

Efficacy and safety of sugammadex versus neostigmine on reversal of amino-steroidal muscle relaxtants induced neuromuscular block： a systematic review

目的系统评价Sugammadex和新斯的明对氨基甾体类肌松药诱导肌肉松弛的拮抗效果和副作用。方法计算机检索PubMed、EBSCO、Springer、Ovid、Embase、CochraneLibrary和CNKI、万方数据库，检索起止时间为从建库至2013年6月。收集Sugammadex和新斯的明用于拮抗肌肉松弛的随机对照试验（randomizedcontrolledtrial，RCT），由2位研究者对纳入研究进行资料提取和质量评价后，采用RevMan5．2软件进行Meta分析。结果纳入6个RCT，包括533例患者。Meta分析：无论是中度还是深度神经肌肉阻滞，Sugammadex组四个成串刺激（train-of-four，TOF）值恢复到70％、80％和90％的平均时间明显快于新斯的明组。深度TOF值恢复到70％、80％、90％的平均时间分别为[WMD=-31．37，95％CI（-39．08，-23．66），P〈0．00001]、lWMD=-39．27，95％CI（-48．48，-30．05），P〈0．00001]和[WMD=-46．36，95％CI（-56．03，-36．69），19〈0．00001]，中度TOF值恢复到70％、80％、90％的平均时间分别为[WMD=-5．13，95％CI（-7。38，-2。89），P〈O．00001]、[WMD-11．65，95％CI（-13．48，-9．82），P〈0．00001]和[WMD=-18．43，95％CI（-23．80，-13．05），P〈0．00001]。同时Sugammadex组患者发生药物相关副作用的概率小于新斯的明组，其差异有统计学意义[OR=0．54，95％CI（0．35，0．85），P=-O．007]。结论在中度和深度神经肌肉阻滞情况下，和新斯的明组比较，Sugammadex组对氨基甾体类肌松药诱导肌肉松弛的拮抗效果更强、安全性更高。

Objective To do systematic review of the efficacy and adverse effect of sugammadex versus neostigmine on reversal of neuromuscular block induced by amino-steroidal muscle relaxants. Methods The relevant randomized controlled trials （RCTs） were searched in PubMed, EBSCO, Springer, Ovid, Embase, Cochrane Library, CNKI and WanFang Data from the date of their establishment to June 2013. The data were extracted and the quality of the included studies was evaluated by two reviewers independently. Then the Meta-analysis was performed with RevMan 5.2 software. Results Six RCTs involving 533 cases were included. Compared to neostigmine, the mean time to recovery of the train-of-four （TOF） ratio to 0.7, 0.8 and 0.9 were significantly shorter in sugammadex cases, regardless of moderate or deep neuromuscular blockade. The mean time to recovery of the TOF ratio to 0.7, 0.8 and 0.9 under deep neuromuscular blockade were [WMD=-31.37, 95%CI（-39.08,-23.66）, P〈O.O00 01 ], [WMD=-39.27, 95%CI（-48.48,-30.05）, P〈0.000 01 ] and [WMD=-46.36, 95%CI（-56.03,-36.69）, P〈0.O00 01 ], respectively. The mean time to recovery of the TOF ratio to 0.7, 0.8 and 0.9 under moderate neuromuscular blockade were [WMD=-5.13, 95%CI （-7.38,-2.89）, P〈0.O00 01 ], [WMD=-ll.65, 95%CI（-13.48, -9.82）, P〈0.O00 01 ] and [WMD=-18.43, 95%CI（23.80,-13.05）,P〈0.000 O1 ], respectively. Compared to neostigmine group, the percentage of patients with drug-related adverse effect was decreased [OR=0.54, 95%CI （0.35, 0.85）, P=0.007] in sugammadex group. Conclusions Both in moderate and deep neuromuscular blockade, the efficacy of sugammadex on reversal of amino-steroidal muscle relaxants induced neuromuscular block was much stronger and safer than that of neostigmine.