■这项研究调查了挥发性麻醉(VA)对接受冠状动脉旁路移植术(CABG)的患者的主要并发症和死亡率的影响。
■这项事后分析包括来自MYRIAD试验的1586名患者,他们在单一机构使用相同的围手术期方案进行管理。患者随机接受挥发性麻醉(七氟醚,异氟烷,或地氟醚)或全静脉麻醉(TIVA)。评估的研究结果是并发症的发生率,包括:心肌梗塞,中风,急性肾损伤,长时间通气(>24小时),接受大剂量正性肌力支持(正性肌力评分>10),并且需要机械循环支持。重症监护病房(ICU)的住院时间,住院时间,随访期间再次入院,还分析了30天和1年死亡率。
■1586例患者在2014年9月至2017年9月之间被纳入,随机分配到挥发性麻醉组(n=794)和TIVA组(n=792)。患者年龄中位数为63岁,射血分数中位数为60%.主要并发症的发生率没有显着差异,ICU住院时间,以及组间住院。芬太尼的中位总剂量在挥发物组为12.0mcg/kg,在TIVA组为14.4mcg/kg(p<0.001)。挥发性和TIVA组的一年死亡率分别为2.5%(n=20)和3.2%(n=25)。分别。与TIVA组的4例患者相比,挥发性组有2例患者在30天和1年的随访中消失。回归分析显示体外循环(CPB)持续时间,芬太尼剂量,基线血清肌酐水平与30天死亡率相关,而射血分数与1年死亡率相关。
■与TIVA相比,在接受CABG的患者中使用VA并未降低主要并发症或死亡率。在TIVA组中使用较高剂量的芬太尼,并且与30天死亡率的增加有关。这些发现值得进一步调查。
■ClinicalTrials.gov(NCT02105610)。
UNASSIGNED: This
study investigated the influence of volatile anesthesia (VA) on major complications and mortality in patients undergoing coronary artery bypass graft surgery (CABG).
UNASSIGNED: This post-hoc analysis included 1586 patients from the MYRIAD
trial managed using the same perioperative protocol at a single institution. Patients were randomized to receive either volatile anesthesia (sevoflurane, isoflurane, or desflurane) or total intravenous anesthesia (TIVA). The assessed
study outcomes were the rate of complications, including: myocardial infarction, stroke, acute kidney injury, prolonged ventilation ( > 24 h), receipt of high-dose inotropic support (inotropic score > 10), and need for mechanical circulatory support. The duration of intensive care unit (ICU) stay, length of hospitalization, hospital readmission during follow-up, 30-days and 1-year mortality were also analyzed.
UNASSIGNED: 1586 patients were enrolled between September 2014-September 2017 and randomly assigned to the volatile anesthesia group (n = 794) and the TIVA group (n = 792). The median patient age was 63 years, with a median ejection fraction of 60%. There were no significant differences in the rates of major complications, duration of ICU stay, and hospitalization between the groups. The median total dose of fentanyl was 12.0 mcg/kg in volatile group and 14.4 mcg/kg in TIVA group (p < 0.001). One-year mortality rates were 2.5% (n = 20) and 3.2% (n = 25) in the volatile and TIVA groups, respectively. Two patients were lost at the 30-day and 1-year follow-ups in the volatile group compared to four patients in TIVA group. Regression analysis showed that cardiopulmonary bypass (CPB) duration, fentanyl dose, and baseline serum creatinine level were associated with 30-days mortality, while ejection fraction was associated with 1-year mortality.
UNASSIGNED: The use of VA in patients undergoing CABG did not result in a reduction in major complications or mortality compared with TIVA. A higher dose of fentanyl was used in the TIVA group and was associated with an increase in the 30-days mortality. These findings warrant further investigation.
UNASSIGNED: ClinicalTrials.gov (NCT02105610).