下肢血管重建手術中使用神經軸索麻醉優於全身麻醉
作者：
小柯機器人發布時間：2020/11/27 13:31:06
加拿大渥太華大學和渥太華醫院Daniel I McIsaac團隊比較了在成人下肢血管重建術中進行神經軸索麻醉或全身麻醉對患者預後的影響。2020年11月25日，該研究發表在《英國醫學雜誌》上。
為了評估神經軸索麻醉或全身麻醉應用於成人下肢血管重建術與臨床結局、住院時長以及再入院率之間的相關性，2002年4月1日至2015年3月31日，研究組在加拿大安大略省進行了一項經驗證的、基於人群、比較有效性的研究，共招募了20988名年齡在18歲以上的本地居民，在每年進行50次及以上手術的醫院中進行了初次下肢血運重建手術。主要結局為30天內的全因死亡，次要結局是院內心肺和腎臟併發症、住院時間和30天內再次入院率。
20988名患者中有6453名（30.7％）接受了神經軸索麻醉，14535名（69.3％）接受了全身麻醉。所研究的醫院中，使用神經軸索麻醉的百分比範圍為0.6％至90.6％不等。但在研究期間，神經軸索麻醉的使用率下降了17％。神經軸索麻醉組中有204位患者（3.2％）在30天內死亡，全身麻醉組中有646位患者（4.4％）。經過多變量、多級校正後，與全身麻醉相比，採用神經軸索麻醉可顯著降低30天死亡率。與全身麻醉相比，使用神經軸索麻醉還可以減少院內心肺和腎臟併發症的機率，縮短住院時間 。
研究結果表明，在下肢血管重建手術中使用神經軸索麻醉，與全身麻醉相比，可顯著減少30天死亡率，縮短住院時間。
附：英文原文
Title: Association between neuraxial anaesthesia or general anaesthesia for lower limb revascularisation surgery in adults and clinical outcomes: population based comparative effectiveness study
Author: Derek J Roberts, Sudhir K Nagpal, Dalibor Kubelik, Timothy Brandys, Henry T Stelfox, Manoj M Lalu, Alan J Forster, Colin JL McCartney, Daniel I McIsaac
Issue&Volume: 2020/11/25
Abstract:
Objective To examine the associations between neuraxial anaesthesia or general anaesthesia and clinical outcomes, length of hospital stay, and readmission in adults undergoing lower limb revascularisation surgery.
Design Comparative effectiveness study using linked, validated, population based databases.
Setting Ontario, Canada, 1 April 2002 to 31 March 2015.
Participants 20988 patients Ontario residents aged 18 years or older who underwent their first lower limb revascularisation surgery in hospitals performing 50 or more of these surgeries annually.
Main outcome measures Primary outcome was 30 day all cause mortality. Secondary outcomes were in-hospital cardiopulmonary and renal complications, length of hospital stay, and 30 day readmissions. Multivariable, mixed effects regression models, adjusting for patient, procedural, and hospital characteristics, were used to estimate associations between anaesthetic technique and outcomes. Robustness of analyses were evaluated by conducting instrumental variable, propensity score matched, and survival sensitivity analyses.
Results Of 20988 patients who underwent lower limb revascularisation surgery, 6453 (30.7%) received neuraxial anaesthesia and 14535 (69.3%) received general anaesthesia. The percentage of neuraxial anaesthesia use ranged from 0.6% to 90.6% across included hospitals. Furthermore, use of neuraxial anaesthesia declined by 17% over the study period. Death within 30 days occurred in 204 (3.2%) patients who received neuraxial anaesthesia and 646 (4.4%) patients who received general anaesthesia. After multivariable, multilevel adjustment, use of neuraxial anaesthesia compared with use of general anaesthesia was associated with decreased 30 day mortality (absolute risk reduction 0.72%, 95% confidence interval 0.65% to 0.79%; odds ratio 0.68, 95% confidence interval 0.57 to 0.83; number needed to treat to prevent one death=139). A similar direction and magnitude of association was found in instrumental variable, propensity score matched, and survival analyses. Use of neuraxial anaesthesia compared with use of general anaesthesia was also associated with decreased in-hospital cardiopulmonary and renal complications (odds ratio 0.73, 0.63 to 0.85) and a reduced length of hospital stay (0.5 days, 0.3 to0.6 days).
Conclusions Use of neuraxial anaesthesia compared with general anaesthesia for lower limb revascularisation surgery was associated with decreased 30 day mortality and hospital length of stay. These findings might have been related to reduced cardiopulmonary and renal complications after neuraxial anaesthesia and support the increased use of neuraxial anaesthesia in patients undergoing these surgeries until the results of a large, confirmatory randomised trial become available.
DOI: 10.1136/bmj.m4104
Source: https://www.bmj.com/content/371/bmj.m4104