Sugammadex vs Neostigmine for Reversal of Neuromuscular Blockade and Association with Postoperative Atelectasis After Video-Assisted Thoracoscopic Surgery: A Propensity Score-Matched Cohort Study.
胸腔镜手术（VATS）后，术后肺不张仍然是一个值得关注的问题。本研究旨在评估sugammadex的使用与接受VATS患者术后肺不张之间的关联。从TriNetX全球协作网络（2016-2024）中，确定了接受选择性胸腔镜手术的成年人，他们接受了sugammadex或新斯的明拮抗的罗库溴铵。主要结局是30天内出现肺不张，使用TriNetX数据库中记录的行政ICD诊断代码进行识别。次要结局包括肺炎、急性呼吸衰竭、气胸、败血症和主要不良心血管事件（MACE）。每隔7天和90天对结果进行额外评估。在倾向评分匹配（1:1）后，每组分析7345名患者。Sugammadex暴露与30天时肺不张的发生率较低相关（比值比[OR]，0.79；95%置信区间[CI]，0.72-0.86；P<0.001），对应绝对风险降低3.3%（15.3%对18.6%）。在7天（OR 0.75）和90天（OR 0.81）的随访中，这种关联保持一致。时间-事件分析表明，肺不张的风险较低（风险比，0.82；95%CI，0.76-0.88）。Sugammadex还与气胸（OR，0.90）和主要不良事件（OR，0.75）减少有关，但与肺炎、呼吸衰竭或败血症无关。亚组分析显示，性别（P=0.003）和肥胖状态（P=0.047）之间存在显著的相互作用，男性和非肥胖患者的关联更为明显。Sugammadex的使用与接受VATS的患者术后肺不张风险的降低有关。前瞻性随机试验有必要证实这些发现并建立因果关系。
Postoperative atelectasis remains a significant concern after video-assisted thoracoscopic surgery (VATS). This study aimed to evaluate the association between sugammadex use and postoperative atelectasis in patients who underwent VATS. From the TriNetX Global Collaborative Network (2016-2024), adults undergoing elective VATS who received rocuronium reversed with either sugammadex or neostigmine were identified. The primary outcome was atelectasis within 30 days, identified using the administrative ICD diagnostic codes recorded in the TriNetX database. The secondary outcomes included pneumonia, acute respiratory failure, pneumothorax, sepsis, and major adverse cardiovascular events (MACEs). Outcomes were additionally assessed at 7-day and 90-day intervals. After propensity score matching (1:1), 7345 patients were analyzed per group. Sugammadex exposure was associated with lower odds of atelectasis at 30 days (odds ratio [OR], 0.79; 95% confidence interval [CI], 0.72-0.86; P < 0.001), corresponding to an absolute risk reduction of 3.3% (15.3% vs 18.6%). The association remained consistent at 7-day (OR, 0.75) and 90-day (OR, 0.81) follow-ups. Time-to-event analysis demonstrated a lower hazard of atelectasis (hazard ratio, 0.82; 95% CI, 0.76-0.88). Sugammadex was also associated with reduced pneumothorax (OR, 0.90) and MACEs (OR, 0.75), but not with pneumonia, respiratory failure, or sepsis. Subgroup analyses revealed significant interactions between sex (P = 0.003) and obesity status (P = 0.047), with more pronounced associations in males and non-obese patients. Sugammadex use was associated with a reduced postoperative atelectasis risk in patients undergoing VATS. Prospective randomized trials are warranted to confirm these findings and establish causality.
Kuo-Chuan Hung, Hsiu-Lan Weng, Jheng-Yan Wu, Chih-Wei Hsu, Chih-Ping Yang, Yi-Chen Lai, et al. Sugammadex vs Neostigmine for Reversal of Neuromuscular Blockade and Association with Postoperative Atelectasis After Video-Assisted Thoracoscopic Surgery: A Propensity Score-Matched Cohort Study.. Drug design, development and therapy. 2026; doi:10.2147/DDDT.S593657.
Kuo-Chuan Hung, Hsiu-Lan Weng, Jheng-Yan Wu, Chih-Wei Hsu, Chih-Ping Yang, Yi-Chen Lai, et al (2026). Sugammadex vs Neostigmine for Reversal of Neuromuscular Blockade and Association with Postoperative Atelectasis After Video-Assisted Thoracoscopic Surgery: A Propensity Score-Matched Cohort Study.. Drug design, development and therapy. https://doi.org/10.2147/DDDT.S593657
Kuo-Chuan Hung, Hsiu-Lan Weng, Jheng-Yan Wu, Chih-Wei Hsu, Chih-Ping Yang, Yi-Chen Lai, et al. Sugammadex vs Neostigmine for Reversal of Neuromuscular Blockade and Association with Postoperative Atelectasis After Video-Assisted Thoracoscopic Surgery: A Propensity Score-Matched Cohort Study.[J]. Drug design, development and therapy, 2026 doi:10.2147/DDDT.S593657.
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