【罂粟摘要】丙泊酚与挥发性麻醉药对肺切除术后肺部并发症的比较：一项随机临床试验
丙泊酚与挥发性麻醉药对肺切除术后肺部并发症的比较：一项随机临床试验
贵州医科大学 高鸿教授课题组
翻译：吴学艳 编辑：佟睿 审校：曹莹
全麻药(丙泊酚和挥发性麻醉药)对单肺通气(OLV)肺切除术后肺转归的影响尚不确定，我们旨在评估静脉麻醉药(丙泊酚)和挥发性麻醉(七氟烷或地氟烷)方案对肺切除术患者的术后肺部并发症(PPCs)影响。
此项前瞻性、随机对照试验，共纳入555名择期OLV肺切除术的成人患者；随机将参与者分为丙泊酚组、七氟烷组、地氟烷组；所有分组均遵循标准的麻醉及通气方案。主要观察为根据加泰罗尼亚外科患者呼吸风险评估(ARISCAT)的术后前7天发生的肺部并发症，包括(呼吸道感染、呼吸衰竭、支气管痉挛、肺不张、胸腔积液、气胸和吸入性肺炎）；次要结果包括PPCs的严重程度和术后主要并发症的分类。采用皮尔逊χ2检验评估主要观察指标组间差异是否具有显著性。
在接受资格评估合格的837名患者中，555名患者采用随机分配，其中丙泊酚组为179名患者，七氟烷组为182名患者，地氟烷组为184名患者，并对545名患者进行分析；复合挥发性麻醉药组(七氟烷和地氟烷）与丙泊酚组的PPCs发生率无差异(21.9%vs24.0%；优势比0.89；95%CI 0.58～1.35；P=0.570);PPCs分级和Clavien-Dindo评分在不同组之间没有显著差异。
与丙泊酚组相比，接受OLV肺切除手术的患者中，使用挥发性麻醉剂组(七氟烷或地氟烷)的全身麻醉并不能减少PPCs;次要观察指标无显著差异。
原始文献来源：
Li XF, Hu JR,et al.Comparative Effect of Propofol and Volatile Anesthetics on Postoperative Pulmonary Complications After Lung Resection Surgery: A Randomized Clinical Trial.Anesth Analg 2021 Jan 06.
Comparative Effect of Propofol and Volatile Anesthetics on Postoperative Pulmonary Complications After Lung Resection Surgery: A Randomized Clinical Trial
Background: The effect of general anesthetics (propofol and volatile anesthetics) on pulmonary outcome after lung resection surgery with one-lung ventilation (OLV) is yet undetermined. We evaluated the effect of intravenous anesthesia (propofol) and volatile anesthesia (sevoflurane or desflurane) regimens on postoperative pulmonary complications (PPCs) in patients undergoing lung resection surgery.
Methods: This prospective, randomized controlled trial enrolled 555 adult patients scheduled for lung resection surgery with OLV. Participants were randomized to 1 of 3 general anesthetic regimens (propofol, sevoflurane, or desflurane). Standard anesthesia and ventilation protocols were followed in all groups. The primary outcome was a composite of PPCs in the first 7 postoperative days. Secondary outcomes included the severity of PPCs and major postoperative complications classification. Intergroup difference in the primary outcome was assessed for significance using the Pearson χ2 test.
Results: Of 837 patients who were assessed for eligibility, 555 were randomized and 545 were analyzed. One hundred and seventy-nine patients were assigned to the propofol group, 182 in the sevoflurane group, and 184 in the desflurane group. The incidence of PPCs did not differ between the combined volatile anesthetics (sevoflurane and desflurane) group and the propofol group (21.9% vs 24.0%; odds ratio, 0.89; 95% confidence interval, 0.58-1.35; P = .570). The PPCs grade and Clavien-Dindo scores did not differ significantly across groups.
Conclusions: In patients undergoing lung resection surgery with OLV, general anesthesia with volatile anesthetics (sevoflurane or desflurane) did not reduce PPCs compared with propofol. No difference in secondary outcomes was observed.