相关实验视频
外周麻醉和中高风险非心脏手术后的生存:基于人口的队列研究
Duminda N Wijeysundera1, W Scott Beattie, Peter C Austin
1Department of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Lancet (London, England)
|August 12, 2008
概括
外周麻醉和止痛药显示,手术患者的30天生存率略有改善. 然而,该效应是边界显著的,而不是改善术后存活率的令人信服的证据.
科学领域:
- 麻醉学 麻醉学
- 外科手术的结果
- 公共卫生 公共卫生
背景情况:
- 外周麻醉和止痛有好处,但它们对术后生存的影响尚不清楚.
- 进行了一项基于人口的队列研究,以调查外科外围麻醉与30天生存率之间的关联.
研究的目的:
- 为了确定外科外围麻醉或止痛是否与接受选择性手术的患者30天生存率的改善有关.
- 评估外围麻醉与30天死亡率在一个大队列之间的关联.
主要方法:
- 在加拿大安大略省 (1994-2004) 接受中高风险非心脏手术的259,037名40岁以上的患者进行了回顾性队列研究.
- 使用倾向得分方法创建匹配对队列,减少组之间的基线差异.
- 外周麻醉与30天死亡率之间的关联在匹配的队列中进行了评估.
主要成果:
- 22%的患者接受了外周麻醉.
- 在匹配的队列中 (n=88,188),外周麻醉与30天死亡率的轻微减少有关 (1.7%对2.0%).
- 死亡的相对风险为0.89 (95% CI为0.81-0.98,p=0.02).
结论:
- 外周麻醉和止痛与30天生存率略有改善有关,但由于边界统计学意义,这一发现需要谨慎解释.
- 生存益处的绝对大小很小 (NNT=477),这表明它没有为改善术后生存提供令人信服的证据.
- 结果支持外科外围麻醉的安全性,用于超出生存改善的指示,如疼痛管理和预防肺部并发症.
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