【罂粟摘要】心脏外科手术中吸入麻醉与全凭静脉麻醉的比较

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心脏外科手术中吸入麻醉与全凭静脉麻醉的比较

贵州医科大学   麻醉与心脏电生理课题组

翻译：杨荣峰

编辑：柏雪

审校：曹莹

背景：挥发性(吸入)麻醉剂具有心脏保护作用，可能改善冠状动脉旁路移植术(CABG)患者的临床结果。

方法：我们在13个国家的36个中心进行了一项实用、多中心、单盲对照试验。计划接受选择性冠脉搭桥的患者被随机分配到吸入麻醉(地氟烷、异氟烷或七氟烷)组或全凭静脉麻醉组。主要结局指标是1年内因任何原因死亡。

结果：共有5400例患者被随机分配:吸入麻醉组2709例，全凭静脉麻醉组2691例。有64%的患者接受了无泵搭桥手术，平均体外循环时间为79分钟。两组在基线时的人口学和临床特征、体外循环持续时间和移植物数量方面相似。在第二次中期分析时，数据和安全监测委员会建议应该停止试验，因为试验无效。收集5353名符合要求的患者数据（99.1％），显示在任何原因导致的1年内死亡方面，两组间无显著差异(吸入麻醉组为2.8%，全静脉麻醉组为3.0%;相对危险度为0.94;95%置信区间[CI]，0.69 -1.29;P = 0.71)，或30天时（分别为1.4％和1.3％；相对危险度，1.11；95％CI，0.70-1.76），此数据收集自5398名符合要求的患者(99.9%)。两组在次要结局或预先规定的不良事件(包括心肌梗死)发生率方面均无显著差异。

结论：在接受选择性冠脉搭桥的患者中，吸入麻醉在1年内的死亡率并没有明显低于全凭静脉麻醉。

原始文献来源：Landoni G;Lomivorotov VV;Nigro Neto C;et al.Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery.N Engl J Med.2019 03 28.DOI:10.1056/NEJMoa1816476.

英文原文：

Volatile Anesthetics versus Total Intravenous

Anesthesia for Cardiac Surgery

BACKGROUND

Volatile (inhaled) anesthetic agents have cardioprotective effects, which might improve clinical outcomes in patients undergoing coronary-artery bypass grafting (CABG).

METHODS

We conducted a pragmatic, multicenter, single-blind, controlled trial at 36 centers in 13 countries. Patients scheduled to undergo elective CABG were randomly as-signed to an  ntraoperative anesthetic regimen that included a volatile anesthetic (desflurane, soflurane, or sevoflurane) or to total intravenous anesthesia. The primary outcome was death from any cause at 1 year.

RESULTS

A total of 5400 patients were randomly assigned: 2709 to the volatile anesthetics group and 2691 to the total intravenous anesthesia group. On-pump CABG was performed in 64% of patients, with a mean duration of cardiopulmonary bypass of 79 minutes. The two groups were similar with respect to demographic and clinical characteristics at baseline, the duration of cardiopulmonary bypass, and the number of grafts. At the time of the second interim analysis, the data and safety monitoring board advised that the trial should be stopped for futility. No significant difference between the groups with respect to deaths from any cause was seen at 1 year (2.8% in the volatile anesthetics group and 3.0% in the total intravenous anesthesia group; relative risk, 0.94; 95% confidence interval [CI], 0.69 1.3%, respectively; relative risk, 1.11; 95% CI, 0.70 to 1.76), with data available for 5398 patients (99.9%). There were no significant differences between the groups in any of the secondary outcomes or in the incidence of prespecified ad-verse events, including yocardial infarction.

CONCLUSIONS

Among patients undergoing elective CABG, anesthesia with a volatile agent did not result in significantly fewer deaths at 1 year than total intravenous anesthesia.

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