学术急诊科快速序贯插管中全剂量琥珀酰胆碱与罗库溴铵的比较：一项回顾性队列研究

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中文摘要

背景： 琥珀酰胆碱和罗库溴铵是用于快速序贯插管（RSI）的主要神经肌肉阻滞剂。既往比较这些药物的研究结果相互矛盾，尽管一项Cochrane综述提示琥珀酰胆碱可能提供更优的插管条件。本研究旨在比较全剂量琥珀酰胆碱（1.5 mg/kg）与罗库溴铵（1.2 mg/kg）在RSI期间的首过成功率、插管条件和围插管期安全性。方法：这项回顾性队列研究于2017年至2021年在单一学术急诊科进行。纳入接受琥珀酰胆碱或罗库溴铵进行RSI的成年患者。主要结局是首过成功率。次要结局是临床可接受的插管条件，探索性安全性结局包括低氧血症、血流动力学变化、血管加压药使用和插管后不良事件。采用逻辑回归确定首过成功率的独立预测因素。结果：共纳入342例患者，其中201例接受琥珀酰胆碱（1.5 mg/kg），141例接受罗库溴铵（1.2 mg/kg）。琥珀酰胆碱与罗库溴铵之间的首过成功率未检测到统计学显著差异（81.6% vs. 79.4%；绝对风险差2.2%；95%置信区间[95% CI] -6.4至10.7；P=0.31）。两组之间在探索性围插管期安全性结局方面未观察到统计学显著差异，包括低氧血症、血流动力学变化或不良事件。罗库溴铵更常用于内分泌合并症患者，这与适应证混杂一致（30.5% vs. 13.9%；P=0.03）。首过成功率的独立预测因素包括使用视频喉镜（调整比值比[aOR] 1.59；95% CI 1.22-4.09，P=0.02）和更丰富的医师经验（aOR 2.12；95% CI 1.09-5.21，P=0.04）。结论：在这项单中心回顾性队列研究中，急诊科RSI期间琥珀酰胆碱与罗库溴铵之间的首过成功率、插管条件和围插管期安全性结局未观察到统计学显著差异。然而，由于该研究并非旨在确立等效性，不能排除临床相关差异。

英文摘要

BACKGROUND Succinylcholine and rocuronium are the principal neuromuscular blocking agents used for rapid sequence intubation (RSI). Prior studies comparing these agents have shown conflicting results, although a Cochrane review suggested that succinylcholine may provide superior intubating conditions. This study aimed to compare the first-pass success rate, intubating conditions, and peri-intubation safety between full-dose succinylcholine (1.5 mg/kg) and rocuronium (1.2 mg/kg) during RSI. METHODS This retrospective cohort study was conducted in a single academic emergency department between 2017 and 2021. Adult patients who underwent RSI with either succinylcholine or rocuronium were included. The primary outcome was the first-pass success rate. The secondary outcome was clinically acceptable intubating conditions, and exploratory safety outcomes included hypoxia, hemodynamic change, vasopressor use, and post-intubation adverse events. Logistic regression was performed to identify independent predictors of the first-pass success rate. RESULTS A total of 342 patients were included, with 201 receiving succinylcholine (1.5 mg/kg) and 141 receiving rocuronium (1.2 mg/kg). There was no statistically significant difference detected on the first-pass success rates between succinylcholine and rocuronium (81.6% vs. 79.4%; absolute risk difference 2.2%; 95% confidence interval [95% CI] -6.4 to 10.7; P=0.31). No statistically significant differences were observed in exploratory peri-intubation safety outcomes, including hypoxia, hemodynamic changes, or adverse events between the groups. Rocuronium was more frequently used in patients with endocrine comorbidities, which is consistent with confounding by indication (30.5% vs. 13.9%; P=0.03). Independent predictors of the first-pass success rates included the use of video laryngoscopy (adjusted odds ratio [aOR] 1.59; 95% CI 1.22-4.09, P=0.02) and greater physician experience (aOR 2.12; 95% CI 1.09-5.21, P=0.04). CONCLUSION In this single-center retrospective cohort study, there was no statistically significant difference observed in the first-pass success rates, intubation conditions, and peri-intubation safety outcomes between succinylcholine and rocuronium during RSI in the emergency department. However, clinically relevant differences cannot be excluded because the study was not designed to establish equivalence.