Objective: To investigate the effect of sugammadex on postoperative nausea and vomiting(PONV) after intracranial aneurysm surgery. Methods: Data from intracranial aneurysms patients who met the inclusion and exclusion criteria and underwent interventional surgery in the Department of Neurosurgery, Peking University International Hospital from January 2020 to March 2021 were prospectively included. According to the random number table method, the patients were divided by 1∶1 into the neostigmine+atropine group (group N) and the sugammadex group (group S). Use an acceleration muscle relaxation monitor for muscle relaxation monitoring, and administer neostigmine+atropine and sugammadex to block residual muscle relaxation drugs after surgery. The incidence rates of PONV and severity, the appearance of anesthesia, and the correlation between PONV and postoperative complications were recorded in both groups during five periods after surgery: 0-0.5 hours (T1),>0.5-2.0 hours(T2),>2.0-6.0 hours (T3),>6.0-12.0 hours (T4) and >12.0-24.0 hours (T5). Group comparisons of quantitative data were performed by the independent sample t-test, and categorical data was performed by the χ2 or rank sum test. Results: A total of 66 patients were included in the study, including 37 males and 29 female, aged (59.3±15.4) years (range: 18 to 77 years). The incidence rates of PONV of 33 patients in group S at different time periods of T1, T2, T3, T4, and T5 after surgery were respectively 27.3%(9/33),30.3%(10/33),12.1%(4/33),3.0%(1/33),0(0/33),and the incidence rates of PONV of 33 patients in the group N at different time periods of T1, T2, T3, T4 and T5 after surgery were respectively 36.4%(12/33),36.4%(12/33),33.3%(11/33),6.1%(2/33) and 0(0/33).The incidence of PONV was lower in the group S only in the T3 period after reversal than in the group N (χ2=4.227, P=0.040).However, there was no statistically significant difference in the incidence of PONV between the two groups of patients in other periods (all P>0.05). The recovery time for spontaneous breathing in patients in group S was (7.7±1.4) minutes, the extubation time was (12.4±5.3) minutes, and the safe exit time for anesthesia recovery was (12.3±3.4) minutes; the N groups were (13.9±2.0) minutes, (18.2±6.0) minutes, and (18.6±5.2) minutes, respectively; three time periods in group S were shorter than those in group N, and the differences were statistically significant (all P<0.05). The results regarding the occurrence of complications in patients with different levels of PONV at different time intervals after surgery in the two groups were as follows: in the T3 time period of group N, a significant difference was observed only in the occurrence of postoperative complications among patients with different levels of PONV (χ2=24.786, P<0.01). However, in the T4 time period, significant differences were found in the occurrence of postoperative complications among both the same level and different level PONV patients (χ2=15.435, 15.435, both P<0.01). Significant differences were also observed in the occurrence of postoperative complications among the same level and different level PONV patients in both the T3 and T4 time periods of group S (all P<0.01). Conclusion: Sugammadex can be used to reverse muscle relaxation in patients undergoing intracranial aneurysm intervention surgery,and it does not have a significant impact on the incidence of PONV, it can also optimize the quality of anesthesia recovery and reduce the incidence of complications after intracranial aneurysm embolization surgery.
目的： 探讨舒更葡萄糖钠对接受颅内动脉瘤介入手术患者发生术后恶心呕吐（PONV）的影响。 方法： 前瞻性纳入2020年1月至2021年3月在北京大学国际医院神经外科行介入手术治疗的符合纳入和排除标准的颅内动脉瘤患者资料。采用随机数字表法按照1∶1比例将患者随机分成新斯的明+阿托品组（N组）与舒更葡萄糖钠组（S组）。使用加速度肌松监测仪进行肌松监测，术毕分别予以新斯的明+阿托品和舒更葡萄糖钠拮抗肌松药残余。记录两组患者术后0~0.5 h（T1）、>0.5~2.0 h（T2）、>2.0~6.0 h（T3）、>6.0~12.0 h（T4）及>12.0~24.0 h（T5）各时间段的PONV发生率、严重程度、麻醉苏醒情况，并分析PONV与术后并发症的关系。定量资料组间比较采用t检验，分类资料的组间比较采用χ2检验或秩和检验。 结果： 共有66例患者纳入本研究，其中男性37例，女性29例，年龄（59.3±15.4）岁（范围：18~77岁）。S组33例患者术后T1、T2、T3、T4、T5各时间段PONV的发生率分别为27.3%（9/33）、30.3%（10/33）、12.1%（4/33）、3.0%（1/33）、0（0/33），N组33例患者分别为36.4%（12/33）、36.4%（12/33）、33.3%（11/33）、6.1%（2/33）、0（0/33）。S组仅在逆转后T3时间段PONV发生率低于N组（χ2=4.227，P=0.040）；而其他时间段两组患者PONV发生率的差异均无统计学意义（P值均>0.05）。S组患者自主呼吸恢复时间为（7.7±1.4）min，拔管时间为（12.4±5.3）min，麻醉恢复安全离室时间为（12.3±3.4）min；N组分别为（13.9±2.0）min、（18.2±6.0）min、（18.6±5.2）min。两组术后不同时间段发生不同级别PONV患者的并发症发生情况显示，N组T3时间段仅不同级别PONV患者发生术后并发症的差异有统计学意义（χ2=24.786，P<0.01）；而T4时间段同一级别PONV和不同级别PONV患者发生术后并发症的差异均有统计学意义（χ2=15.435、15.435，P值均<0.01）。S组T3、T4时间段同一级别PONV和不同级别PONV患者发生术后并发症的差异均有统计学意义（P值均<0.01）。 结论： 舒更葡萄糖钠可用于颅内动脉瘤介入手术患者术后逆转肌松，且对PONV发生率无明显影响，同时可优化麻醉苏醒质量，降低颅内动脉瘤栓塞术后并发症发生率。.