比較新型與傳統型神經肌肉逆轉劑於老年膝關節置換術患者麻醉安全之回溯調查

A Retrospective Study Comparing the Anesthesia Safety of Novel and Traditional Neuromuscular Reversal Agents in Elderly Patients Receiving knee Arthroplasty

目的：全球老年人口逐年增加，高齡手術麻醉及甦醒成為重要議題。新型逆轉劑能加速逆轉神經肌肉阻斷、降低合併症之發生並促使患者盡早脫離呼吸器。故本研究目的在調查新型與傳統型神經肌肉逆轉劑對於老年膝關節置換術患者麻醉恢復成效。方法：運用回溯比較性研究法，收集2020年01月31日至2021年01月31日，中部某醫院資料庫接受「全膝關節置換手術」之住院老年患者病歷資料共210位。研究資料分為新型逆轉劑組及傳統新型逆轉劑組進行麻醉期照護及麻醉恢復期安全分析。結果：新型神經肌肉逆轉劑相較於傳統組在拔管時間（p＜0.05）及整體手術時間有縮短（p＜0.01），新型神經肌肉逆轉劑組在麻醉恢復期之活動、意識情況及轉入護理照護總分恢復較為迅速，且顯著高於傳統逆轉劑組（p＜0.01）。此外，兩組在轉入與轉出時恢復室血氧飽和濃度、留滯時間及恢復期品質分析皆無差異。結論：全身麻醉下執行膝關節置換術之老年病患，在接受新型神經肌肉逆轉劑可能減短意識回復及自主呼吸的時間，並符合麻醉安全指標。

Purposes: The elderly population in Taiwan has been increasing, and both anesthesia and emergence from anesthesia in elderly persons have become important issues. A novel reversal agent may accelerate the reversal of neuromuscular blockade, reduce complications, and promote the withdrawal of the ventilator as soon as possible. Therefore, this study aimed to investigate the effectiveness of novel and traditional neuromuscular reversal agents for anesthesia recovery in elderly patients receiving knee arthroplasty. Methods: A retrospective comparative approach was adopted, and the medical records of 210 elderly patients who received total knee replacement surgery in a hospital in central Taiwan from January 31, 2020, to January 31, 2021, were collected. The research data were divided into the novel and the traditional neuromuscular reversal agent groups for the analysis of anesthesia care and safety during the anesthesia emergence period. Results: The extubation time (p＜0.05) and the overall operation time (p＜0.01) of the novel neuromuscular reversal agent group were shorter when compared with the traditional group. During the emergence from anesthesia period, the recovery of activity and consciousness and the total score of nursing assessment after transfer of the novel reversal agent group to the recovery room were superior in the novel reversal agent group, with significantly higher scores than that of the traditional reversal agent group (p＜0.01). In addition, there were no differences in the blood oxygen saturation concentrations upon transferring in and out of the recovery room, during detention duration, and in the quality of recovery between the two groups. Conclusions: Elderly patients receiving knee arthroplasty under general anesthesia who received the novel neuromuscular reversal agent had shorter time of recovery of consciousness and spontaneous breathing, and the novel neuromuscular reversal agent met the safety criteria for anesthesia.