外周麻醉和止痛以及重大手术的结果:一项随机试验
John R A Rigg1, Konrad Jamrozik, Paul S Myles
1Department of Public Health, University of Western Australia, Western, Crawley, Australia. john.rigg@sjog.org.au
Lancet (London, England)
|April 20, 2002
概括
外周麻醉与全身麻醉相结合并没有显著减少高风险手术患者的整体不良结果. 然而,它确实降低了呼吸衰竭率并改善了疼痛管理,这表明对特定患者有好处.
科学领域:
- 麻醉学 麻醉学
- 外科手术的结果
- 关键护理医学 关键护理医学
背景情况:
- 腹膜阻塞是主要腹部手术的常见止痛技术.
- 在高风险的外科手术患者中,外周支柱阻塞的风险和益处存在不确定性.
- 多中心随机试验对于评估复杂的麻醉策略至关重要.
研究的目的:
- 为了比较高风险患者的不良结果,这些患者接受了使用外围阻塞和替代止痛疗法进行的大型腹部手术.
- 在高风险的手术群体中评估结合外围麻醉和全身麻醉的疗效和安全性.
- 评估外围麻醉对术后发病率和死亡率的影响.
主要方法:
- 一个多中心随机试验,涉及915名接受重大腹部手术的高风险患者.
- 患者被分配给接受手术期间的外周麻醉和72小时的术后外周麻醉与全身麻醉或对照组.
- 主要终点是30天死亡率或重大术后发病率,根据治疗意图进行分析.
主要成果:
- 在外周支架组 (57.1%) 和对照组 (60.7%) 之间,死亡或重大发病的复合终点没有显著差异.
- 在两组中,30天死亡率低且相似 (5.1%的外周注射与4.3%的对照).
- 外周术技术与呼吸衰竭的显著减少 (23%与30%相比) 和手术后疼痛得分的改善有关.
结论:
- 结合外围麻醉和全身麻醉以及术后外围麻醉并没有减少高风险手术患者的大多数不良结果.
- 观察到的呼吸衰竭的减少和改善的止痛疗法表明,对特定的高风险患者群体有潜在的益处.
- 与外周导管插入相关的严重不良事件的低发病率支持其在这个人群中的安全性.
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