Volatile Anesthetics Reduce Mortality in Cardiac Surgery
Volatile Anesthetics Reduce Mortality in Cardiac Surgery
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DOI：
10.1053/j.jvca.2009.01.022
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发表时间：
2009-10-01
影响因子：
2.8
通讯作者：
Zangrillo, Alberto
中科院分区：
文献类型：
--
作者：
Bignami, Elena;Biondi-Zoccai, Giuseppe;Zangrillo, Alberto
目的：最近的一项荟萃分析表明，挥发性麻醉药可降低心脏手术后的死亡率。尽管如此，挥发性麻醉药是否能改善心脏手术患者的预后仍是一个有争议的问题。作者调查了是否使用挥发性麻醉剂降低死亡率在心脏surgic.Design，设置和干预：一项纵向研究的34，310冠状动脉旁路移植术在意大利进行的干预措施，估计风险调整后的死亡率比为每个中心。在这些中心进行了一项调查，以调查是否使用挥发性麻醉药显示与mortality. Measures和主要结果：所有64个合格的中心提供了所需的数据。参与中心的中位未校正30天死亡率为2.2%（0.3-8.8），而中位风险校正30天死亡率为1.8%（0.1-7.2）。风险调整分析显示，使用挥发性麻醉剂与风险调整后的30天死亡率显著降低相关（β = -1.172 [-2.259，-0.085]，R-2 = 0.070，p = 0.035）。在至少25%的病例或少于25%的病例中使用挥发性麻醉剂的中心二分产生了更具有统计学意义的结果（p = 0.003）。此外，使用挥发性麻醉剂的时间越长，死亡率越低（p = 0.022）;探索特定挥发性麻醉剂的影响，异氟烷的使用与风险调整后死亡率的显著降低相关结论：在64个意大利中心进行的这项调查显示，在接受冠状动脉旁路移植术的患者中使用挥发性药物可能会降低风险调整后的死亡率。(C)2009 Elsevier Inc.版权所有
Objectives: A recent meta-analysis suggested that volatile anesthetics reduce postoperative mortality after cardiac surgery. Nonetheless, whether volatile anesthetics improve the outcome of cardiac surgical patients is still a matter of debate. The authors investigated whether the use of volatile anesthetics reduces mortality in cardiac surgery.Design, Setting, and Interventions: A longitudinal study of 34,310 coronary artery bypass graft interventions performed in Italy estimated the risk-adjusted mortality ratio for each center. A survey was conducted among these centers to investigate whether the use of volatile anesthetics showed a correlation with mortality.Measurements and Main Results: All 64 eligible centers provided the required data. The median unadjusted 30-day mortality among participating centers was 2.2% (0.3-8.8), whereas the median risk-adjusted 30-day mortality was 1.8% (0.1-7.2). Risk-adjusted analysis showed that the use of volatile anesthetics was associated with a significantly lower rate of risk-adjusted 30-day mortality (beta = -1.172 [-2.259, -0.085], R-2 = 0.070, p = 0.035). Dichotomization into centers using volatile anesthetics in at least 25% of their cases or in less than 25% yielded even more statistically significant results (p = 0.003). Furthermore, a longer use of volatile anesthetics was associated with a significantly lower death rate (p = 0.022); and exploring the impact of the specific volatile anesthetic agent, the use of isoflurane was associated with significant reductions in risk-adjusted mortality rates (p = 0.039).Conclusions: This survey among 64 Italian centers shows that risk-adjusted mortality may be reduced by the use of volatile agents in patients undergoing coronary artery bypass graft surgery. (C) 2009 Elsevier Inc. All rights reserved