大型手术后麻醉深度和并发症:国际随机对照试验
Timothy G Short1, Douglas Campbell1, Christopher Frampton2
1Auckland City Hospital, Auckland, New Zealand; University of Auckland, Auckland, New Zealand.
Lancet (London, England)
|October 25, 2019
概括
在老年手术患者中,轻度全身麻醉与深度全身麻醉相比没有降低1年死亡率. 这项研究提供了关于重大手术安全麻醉深度范围的证据.
科学领域:
- 麻醉学和重症监护医学
- 手术结果和患者安全
- 老年医学
背景情况:
- 观察性研究表明,深度麻醉与术后存活率降低之间存在联系.
- 随机对照试验证据比较不同麻醉深度的死亡率是有限的.
- 这项研究解决了对麻醉深度和患者结果缺乏高质量的证据的问题.
研究的目的:
- 在接受重大手术的老年患者中比较1年全因死亡率.
- 评估轻度全身麻醉与深度全身麻醉的安全性和有效性.
- 确定双光谱指数 (BIS) 目标对患者存活时间的影响.
主要方法:
- 国际随机对照试验涉及6644名60岁以上的高风险患者接受重大手术.
- 患者被分配到轻度全身麻醉 (BIS目标50) 或深度全身麻醉 (BIS目标35).
- 主要结局是1年全因死亡率,患者和评估人员的分配被掩盖.
主要成果:
- 在轻度麻醉组 (BIS 50) 的1年死亡率为6. 5%,在深度麻醉组 (BIS 35) 的7. 2%.
- 两组之间1年死亡率没有显著差异 (危险比率为0.88,95% CI为0.73至1. 07).
- 在两组中观察到类似的3级和4级不良事件.
结论:
- 与深度全身麻醉相比,轻度全身麻醉与1年死亡率的降低无关.
- 这些发现表明使用处理的脑电图监测可以安全地管理广泛的麻醉深度.
- 这项试验为优化高风险手术患者的麻醉管理提供了有价值的数据.
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