术程镇静和镇痛与整体麻醉用于镜肌切除术 (PROSECCO试验):一个多中心随机对照试验
Julia F van der Meulen1,2, Marlies Y Bongers1,2, Lisa G van der Zee3
1Department of Obstetrics & Gynecology, Máxima Medical Centre, Veldhoven, the Netherlands.
PLoS medicine
|December 28, 2023
概括
使用程序性镇静和镇痛 (PSA) 进行纤维瘤的透镜性肌肉切除并未被证明对全切除的全麻醉 (GA) 不逊色. 然而,PSA是一种安全的替代方案,导致住院时间缩短和类似的临床结果.
科学领域:
- 妇科 妇科医生 妇科
- 麻醉学 麻醉学
- 手术瘤学手术瘤学
背景情况:
- 镜切除是对症状类型0和1纤维瘤的主要治疗方法.
- 传统上是在全身麻醉下进行的,手术正在转移到门诊环境中,使用手术镇静.
- 有限的数据存在于hysteroscopic myomectomy在手术镇静下的安全性和有效性.
研究的目的:
- 为了评估在程序性镇静和镇痛 (PSA) 下使用普罗波福的透性肌肉切除术是否与全身麻醉 (GA) 不逊色.
- 为了比较使用PSA与GA的透镜肌肉切除术的安全性和有效性.
主要方法:
- 一个多中心,随机控制的非劣势性试验,涉及209名女性.
- 参与者被随机分配到PSA下用普罗波或GA进行透性肌肉切除术.
- 主要结局是术后6周通过超声波评估的完整切除率.
主要成果:
- 在PSA组的87.8%的女性和GA组的88.8%的女性中发生了完全切除 (P=0.09为非劣势).
- 没有报告严重的麻醉并发症,并且不需要从PSA转换为GA.
- 严重的不良事件 (一夜间住院) 与干预无关,发生在15名妇女身上.
结论:
- 没有证明完全切除的非劣质性,但PSA显示了可比的临床结果和生活质量.
- 与PSA进行的透性肌肉切除术是安全的,并且与GA相比,与更短的住院时间有关.
- 在门诊环境中,PSA是一种可行的选择,可以用于异构肌肉切除术,以帮助患者咨询.
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