吸入全麻与静脉全麻用于心脏手术对术后结局影响的比较
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Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery
背景与目的
挥发性（吸入）麻醉剂具有心脏保护作用，可改善冠状动脉旁路移植术（CABG）患者的临床结局。
方 法
我们在13个国家的36个机构中进行了一项实用、多中心、单盲、对照试验。择期进行CABG的患者被随机分为吸入全麻组（地氟醚、异氟醚或七氟醚）和静脉全麻组。1年内任何原因引起的死亡作为主要结局。
结 果
收集的5400例患者被随机分为：吸入全麻组2709例、静脉全麻组2691例。64%患者行泵式冠状动脉旁路移植术，体外循环的平均持续时间为79min。两组基础的人口统计学和临床特征、体外循环持续时间、移植物数量方面均相似。第二次中期分析时，数据和安全监测委员会建议试验无效应停止。两组在1年内任何原因引起的死亡方面无统计学差异，其中有5353例患者（99.1%）的数据可用（吸入性全麻组为2.8%，静脉全麻组为3.0%；RR：0.94；95%CI：0.69 - 1.29；P=0.71）；两组在30天内任何原因引起的死亡方面也无统计学差异，其中有5398例患者（99.9%）的数据可用。两组在任何次要结局或预先指定的不良事件（包括心肌梗死）发生率方面均无显著差异。
结 论
在接受选择性冠状动脉旁路移植术的患者中，采用吸入全麻的1年内的死亡率并没有明显低于静脉全麻。
原始文献摘要
Landoni G, Lomivorotov VV, Nigro Neto C,et al.Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery[J].N Engl J Med, 2019 Mar 28;380(13):1214-1225.
BACKGROUND：Volatile (inhaled) anesthetic agents have cardioprotective effects, which might improve clinical outcomes in patients undergoing coronaryartery 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 assigned to an intraopera-tive anesthetic regimen that included a volatile anesthe-tic (desflurane, isoflurane, 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. Onpump 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 cardiopulmo-nary 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 to 1.29; P=0.71), with data available for 5353 patients (99.1%), or at 30 days (1.4% and 1.3%, respec-tively; relative risk, 1.11; 95% CI, 0.70 to 1.76), with data available or 5398 patients (99.9%). There were no significant differences bet-ween the groups in any of the secondary outcomes or in the inci-dence of prespecified adverse events, including myocardial infar-ction.
CONCLUSIONS：Among patients undergoing elective CABG, anes-thesia with a volatile agent did not result in significantly fewer dea-ths at 1 year than total intravenous anesthesia.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：冯玉蓉 编辑：何幼芹 审校：王贵龙