Progress of residual neuromuscular blockade after general anesthesia in elderly patients
LIU Qiuli,, JIANG Lai, WENG Xiaojian,
Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
Muscle relaxation induced by muscle relaxants is one of the important conditions for endotracheal intubation and fixation, but sometimes muscle functions recover incompletely after operations, which is called postoperative residual neuromuscular block (PRNB). It can cause a series of serious postoperative complications and even death. Hence, it is essential to prevent and treat PRNB in the early stage during anesthesia implementation. With the rapid development of surgical technology and the gradual extension of the life span of the population, the number of operations for elderly patients is gradually increasing. Meanwhile, due to the physiological and pathological changes of the elderly and the combined underlying diseases, the elderly are more likely to suffer from PRNB in different degrees after surgery, which seriously damages the prognosis of elderly patients and increases the loss of medical resources. In these years, the successful application of short-acting muscle relaxants, new antagonists (such as sugammadex), and multi-mode neuromuscular monitoring devices in clinical practice have greatly reduced the incidence of PRNB in elderly patients. Furthermore, the basic researches which mainly based on the neuromuscular junction structure and the pharmacokinetic and pharmacodynamic studies of the elderly provide a new theoretical basis for reducing the harm of PRNB to elderly patients. This paper reviews the research progress of the mechanism, adverse events and clinical interventions of PRNB in elderly patients after general anesthesia surgeries to provide reference for muscle relaxation management and postoperative antagonism in these people.
LIU Qiuli, JIANG Lai, WENG Xiaojian. Progress of residual neuromuscular blockade after general anesthesia in elderly patients. Journal of Shanghai Jiao Tong University (Medical Science)[J], 2023, 43(1): 108-113 doi:10.3969/j.issn.1674-8115.2023.01.014
PRNB是指全麻术毕肌松药作用尚存、未充分代谢完毕，患者临床上表现为吞咽无力、呼吸肌功能下降、握持不能等，严重者可出现反流性误吸、低氧血症，甚至有死亡的风险［6］。近年来，普遍认为判断PRNB的金标准是指4个成串刺激比值（train of four stimulation ratio，TOFr）<0.9［7］。在一项前瞻性队列研究［8］中发现，PRNB不良事件的发生率在实施全麻的老年患者中达57.7%，而在全麻的年轻患者中为30.0%。老年患者因PRNB引发的各类并发症发生率增加、不良事件死亡率逐年上升，同时PRNB也造成了医疗资源的大量浪费［8-9］。但研究［10-11］表明，19.3%的欧洲麻醉医师和9.4%的美国麻醉医师从不执行术中肌松监测。
临床研究［26］表明，肌松作用的不完全恢复与肺部并发症等术后不良事件的发生密切相关，包括苏醒延迟、低氧血症、肺不张、肺炎和呼吸衰竭等。大多数老年患者随年龄增长呼吸系统功能下降，与年轻人相比，老年人PRNB及相关不良后果的风险增加［8］。在一项针对599例全麻中使用肌松药的成年患者进行的前瞻性队列研究［22］发现，PRNB患者在麻醉恢复室（postanesthesia care unit，PACU）中发生呼吸不良事件的频率更高，并与年龄显著相关。
LIU Qiuli conceived the idea and drafted the original manuscript；WENG Xiaojian and JIANG Lai participated in the reviewing and editing. All the authors have read the last version of paper and consented for submission.
利益冲突声明
所有作者声明不存在利益冲突。
All authors disclose no relevant conflict of interests.
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... PRNB是指全麻术毕肌松药作用尚存、未充分代谢完毕，患者临床上表现为吞咽无力、呼吸肌功能下降、握持不能等，严重者可出现反流性误吸、低氧血症，甚至有死亡的风险［6］.近年来，普遍认为判断PRNB的金标准是指4个成串刺激比值（train of four stimulation ratio，TOFr）<0.9［7］.在一项前瞻性队列研究［8］中发现，PRNB不良事件的发生率在实施全麻的老年患者中达57.7%，而在全麻的年轻患者中为30.0%.老年患者因PRNB引发的各类并发症发生率增加、不良事件死亡率逐年上升，同时PRNB也造成了医疗资源的大量浪费［8-9］.但研究［10-11］表明，19.3%的欧洲麻醉医师和9.4%的美国麻醉医师从不执行术中肌松监测. ...
... PRNB是指全麻术毕肌松药作用尚存、未充分代谢完毕，患者临床上表现为吞咽无力、呼吸肌功能下降、握持不能等，严重者可出现反流性误吸、低氧血症，甚至有死亡的风险［6］.近年来，普遍认为判断PRNB的金标准是指4个成串刺激比值（train of four stimulation ratio，TOFr）<0.9［7］.在一项前瞻性队列研究［8］中发现，PRNB不良事件的发生率在实施全麻的老年患者中达57.7%，而在全麻的年轻患者中为30.0%.老年患者因PRNB引发的各类并发症发生率增加、不良事件死亡率逐年上升，同时PRNB也造成了医疗资源的大量浪费［8-9］.但研究［10-11］表明，19.3%的欧洲麻醉医师和9.4%的美国麻醉医师从不执行术中肌松监测. ...
3
... PRNB是指全麻术毕肌松药作用尚存、未充分代谢完毕，患者临床上表现为吞咽无力、呼吸肌功能下降、握持不能等，严重者可出现反流性误吸、低氧血症，甚至有死亡的风险［6］.近年来，普遍认为判断PRNB的金标准是指4个成串刺激比值（train of four stimulation ratio，TOFr）<0.9［7］.在一项前瞻性队列研究［8］中发现，PRNB不良事件的发生率在实施全麻的老年患者中达57.7%，而在全麻的年轻患者中为30.0%.老年患者因PRNB引发的各类并发症发生率增加、不良事件死亡率逐年上升，同时PRNB也造成了医疗资源的大量浪费［8-9］.但研究［10-11］表明，19.3%的欧洲麻醉医师和9.4%的美国麻醉医师从不执行术中肌松监测. ...
... 临床研究［26］表明，肌松作用的不完全恢复与肺部并发症等术后不良事件的发生密切相关，包括苏醒延迟、低氧血症、肺不张、肺炎和呼吸衰竭等.大多数老年患者随年龄增长呼吸系统功能下降，与年轻人相比，老年人PRNB及相关不良后果的风险增加［8］.在一项针对599例全麻中使用肌松药的成年患者进行的前瞻性队列研究［22］发现，PRNB患者在麻醉恢复室（postanesthesia care unit，PACU）中发生呼吸不良事件的频率更高，并与年龄显著相关. ...
2
... PRNB是指全麻术毕肌松药作用尚存、未充分代谢完毕，患者临床上表现为吞咽无力、呼吸肌功能下降、握持不能等，严重者可出现反流性误吸、低氧血症，甚至有死亡的风险［6］.近年来，普遍认为判断PRNB的金标准是指4个成串刺激比值（train of four stimulation ratio，TOFr）<0.9［7］.在一项前瞻性队列研究［8］中发现，PRNB不良事件的发生率在实施全麻的老年患者中达57.7%，而在全麻的年轻患者中为30.0%.老年患者因PRNB引发的各类并发症发生率增加、不良事件死亡率逐年上升，同时PRNB也造成了医疗资源的大量浪费［8-9］.但研究［10-11］表明，19.3%的欧洲麻醉医师和9.4%的美国麻醉医师从不执行术中肌松监测. ...
... GRABITZ等［9］研究表明，相较于青年人群，老年人群发生术后残留神经肌肉阻滞与重症监护病房（intensive care unit，ICU）入住率增高、PACU停留时间增加及住院时间延长显著相关，甚至术后患者死亡风险也会升高，这些对医疗资源的利用和周转造成了一定影响. ...
1
... PRNB是指全麻术毕肌松药作用尚存、未充分代谢完毕，患者临床上表现为吞咽无力、呼吸肌功能下降、握持不能等，严重者可出现反流性误吸、低氧血症，甚至有死亡的风险［6］.近年来，普遍认为判断PRNB的金标准是指4个成串刺激比值（train of four stimulation ratio，TOFr）<0.9［7］.在一项前瞻性队列研究［8］中发现，PRNB不良事件的发生率在实施全麻的老年患者中达57.7%，而在全麻的年轻患者中为30.0%.老年患者因PRNB引发的各类并发症发生率增加、不良事件死亡率逐年上升，同时PRNB也造成了医疗资源的大量浪费［8-9］.但研究［10-11］表明，19.3%的欧洲麻醉医师和9.4%的美国麻醉医师从不执行术中肌松监测. ...
1
... PRNB是指全麻术毕肌松药作用尚存、未充分代谢完毕，患者临床上表现为吞咽无力、呼吸肌功能下降、握持不能等，严重者可出现反流性误吸、低氧血症，甚至有死亡的风险［6］.近年来，普遍认为判断PRNB的金标准是指4个成串刺激比值（train of four stimulation ratio，TOFr）<0.9［7］.在一项前瞻性队列研究［8］中发现，PRNB不良事件的发生率在实施全麻的老年患者中达57.7%，而在全麻的年轻患者中为30.0%.老年患者因PRNB引发的各类并发症发生率增加、不良事件死亡率逐年上升，同时PRNB也造成了医疗资源的大量浪费［8-9］.但研究［10-11］表明，19.3%的欧洲麻醉医师和9.4%的美国麻醉医师从不执行术中肌松监测. ...
... 临床研究［26］表明，肌松作用的不完全恢复与肺部并发症等术后不良事件的发生密切相关，包括苏醒延迟、低氧血症、肺不张、肺炎和呼吸衰竭等.大多数老年患者随年龄增长呼吸系统功能下降，与年轻人相比，老年人PRNB及相关不良后果的风险增加［8］.在一项针对599例全麻中使用肌松药的成年患者进行的前瞻性队列研究［22］发现，PRNB患者在麻醉恢复室（postanesthesia care unit，PACU）中发生呼吸不良事件的频率更高，并与年龄显著相关. ...
... 临床研究［26］表明，肌松作用的不完全恢复与肺部并发症等术后不良事件的发生密切相关，包括苏醒延迟、低氧血症、肺不张、肺炎和呼吸衰竭等.大多数老年患者随年龄增长呼吸系统功能下降，与年轻人相比，老年人PRNB及相关不良后果的风险增加［8］.在一项针对599例全麻中使用肌松药的成年患者进行的前瞻性队列研究［22］发现，PRNB患者在麻醉恢复室（postanesthesia care unit，PACU）中发生呼吸不良事件的频率更高，并与年龄显著相关. ...
