General anaesthesia is associated with adverse cardiac outcome after endovascular aneurysm repair.
General anaesthesia is associated with adverse cardiac outcome after endovascular aneurysm repair.
复制标题
全身麻醉与血管内动脉瘤修复术后不良心脏结局相关。
DOI：
10.1016/j.ejvs.2012.04.028
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
R. Stolker
中科院分区：
文献类型：
--
作者：
E. J. Bakker;K. M. van de Luijtgaarden;F. van Lier;T. Valentijn;S. Hoeks;M. Klimek;H. Verhagen;R. Stolker
目的与开放修复相比，血管内动脉瘤修复（EVAR）可减少心脏应激，是一种有吸引力的治疗选择，特别是对于心脏脆弱的患者。全身麻醉和局部麻醉在手术引起的应激反应方面有所不同。本研究的目的是比较全麻或局部麻醉下 EVAR 后心脏事件的发生率。 方法 这项回顾性队列研究对 2002 年至 2011 年间连续接受肾下 EVAR 的 302 名患者进行了分析。麻醉类型的选择由治疗医生决定。获得病史、药物使用、麻醉技术和随访情况。研究终点是30天的心脏并发症，包括心源性死亡、非致命性心肌梗塞、心力衰竭、室性心律失常和肌钙蛋白T释放。根据修订的心脏风险指数对接受局部技术的倾向和心脏危险因素进行调整的多变量分析用于评估心脏事件与麻醉类型之间的关联。 结果共有 173 名患者接受了全身麻醉，129 名患者接受了局部麻醉。接受全身麻醉的患者中，肥胖、使用阿司匹林和治疗性抗凝治疗更为常见。在接受全身麻醉的患者中观察到心脏事件的比例为 13.3%，在接受局部麻醉的患者中观察到心脏事件的比例为 4.7%（P = 0.02），当终点中排除无症状肌钙蛋白释放时，这一比例为 6.4% 与 0.8%（P = 0.02）。全麻组发生2例心源性死亡、6例非致命性心肌梗死、2例非致命性心力衰竭、1例非致命性心脏骤停和12例肌钙蛋白T释放，而局部麻醉组发生1例心肌梗死和5例肌钙蛋白T释放。在多变量分析中，全身麻醉与不良心脏事件相关（比值比 (OR) 3.8；95% 置信区间 (CI) 1.1–12.9）。两组患者中非心脏并发症的发生率为 11.6% (P = 1.00)。 结论 与局部麻醉相比，全身麻醉与 EVAR 中心脏事件风险增加相关。
OBJECTIVESEndovascular aneurysm repair (EVAR) is associated with reduced cardiac stress compared with open repair and is an attractive therapeutic option, especially in cardiac fragile patients. General and locoregional anaesthesia differ regarding the stress response evoked by surgery. The aim of the study is to compare the incidence of cardiac events after EVAR under general or locoregional anaesthesia.METHODSA total of 302 consecutive patients undergoing infrarenal EVAR between 2002 and 2011 were analysed in this retrospective cohort study. Selection of anaesthesia type was at the discretion of the treating physicians. Medical history, medication use, anaesthesia technique and follow-up were obtained. The study end point was 30-day cardiac complications, including cardiac death, non-fatal myocardial infarction, heart failure, ventricular arrhythmia and troponin T release. Multivariable analysis, adjusted for the propensity of receiving a locoregional technique and cardiac risk factors according to the Revised Cardiac Risk Index, was used to assess the association between cardiac events and anaesthesia type.RESULTSA total of 173 patients underwent general anaesthesia and 129 locoregional anaesthesia. Obesity, aspirin use and therapeutic anticoagulation were more common in patients receiving general anaesthesia. Cardiac events were observed in 13.3% of patients receiving general anaesthesia and in 4.7% of patients receiving locoregional anaesthesia (P = 0.02), or 6.4% versus .8% (P = 0.02) when asymptomatic troponin release is excluded from the end point. In the general anaesthesia group, two cardiac deaths, six non-fatal myocardial infarctions, two cases of non-fatal heart failure, one non-fatal cardiac arrest and 12 cases of troponin T release were observed, compared with one myocardial infarction and five cases of troponin T release in the locoregional anaesthesia group. In multivariable analysis, general anaesthesia was associated with adverse cardiac events (odds ratio (OR) 3.8; 95%-confidence interval (CI) 1.1–12.9). Non-cardiac complications occurred in 11.6% of patients in both groups (P = 1.00).CONCLUSIONGeneral anaesthesia was associated with an increased risk of cardiac events in EVAR, compared with locoregional anaesthesia.
影响因子：
4.3
作者：
Edwards MS;Andrews JS;Edwards AF;Ghanami RJ;Corriere MA;Goodney PP;Godshall CJ;Hansen KJ
通讯作者：
Hansen KJ