与地氟醚麻醉相比，异丙酚麻醉与肝切除术后肝细胞癌患者更好的生存率相关：一项回顾性队列研究
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Propofol-based total intravenous anaesthesia is associated with better survival than desflurane anaesthesia in hepatectomy for hepatocellular carcinoma: a retrospective cohort study
背景与目的
研究表明麻醉药物及麻醉方式可影响癌症手术患者的临床结局，本研究探讨肝细胞癌选择性肝切除术患者术后麻醉药物及麻醉方式与患者预后的关系。
方 法
本试验为一项对2005年1月至2014年12月接受肝细胞癌选择性肝切除术患者的回顾性单中心队列研究，患者按异丙酚或地氟醚麻醉分组。进行Kaplanemier分析，构建从手术到死亡的生存曲线。倾向匹配后，采用单变量和多变量Cox回归模型比较死亡风险比。 对肿瘤深转移分期、远处转移和局部复发进行亚组分析。
结 果
共有492例地氟烷麻醉患者（369例死亡，75.0%）和452例异丙酚麻醉患者（139例死亡，30.8%）符合分析条件。倾向匹配后，每组有335名患者。在匹配分析中，异丙酚麻醉的存活率较高，危险比为0.47（95%置信区间，0.38-0.59；P<0.001）。亚组分析也显示，异丙酚组在无远处转移（危险比0.47；95%可信区间，0.37-0.60；P<0.001）或局部复发（危险比0.22；95%可信区间，0.14-0.34；P<0.001）的情况下生存率显著提高。
结 论
异丙酚麻醉与肝切除术后肝细胞癌患者更好的生存率相关。目前尚需要前瞻性研究评估异丙酚麻醉对肝细胞癌患者手术结局的影响。
原始文献摘要
Lai HC, Lee MS, Lin C,et al.Propofol-based total intravenous anaesthesia is associated with better survival than desflurane anaesthesia in hepatectomy for hepatocellular carcinoma: a retrospective cohort study. Br J Anaesth. 2019 Jun 3. pii: S0007-0912(19)30371-X. doi: 10.1016/j.bja.2019.04.057. [Epub ahead of print] PubMed PMID: 31171343.
Background: Previous studies have shown that anaesthetic technique can affect outcomes of cancer surgery. We investigated the association between anaesthetic technique and patient outcomes after elective hepatectomy for hepatocellular carcinoma.
Methods: This was a retrospective single-centre cohort study of patients who received elective hepatectomy for hepatocellular carcinoma from January 2005 to December 2014. Patients were grouped according to propofol or desflflurane anaesthesia. Kaplane Meier analysis was performed and survival curves were constructed from the date of surgery to death. After propensity matching, univariable and multivariable Cox regression models were used to compare hazard ratios for death. Subgroup analyses were performed for tumour-node-metastasis staging and distant metastasis and local recurrence.
Results: A total of 492 patients (369 deaths, 75.0%) with desflflurane anaesthesia and 452 (139 deaths, 30.8%) with propofol anaesthesia were eligible for analysis. After propensity matching, 335 patients remained in each group. In the matched analysis, propofol anaesthesia had a better survival with hazard ratio of 0.47 (95% confifidence interval, 0.38-0.59; P<0.001). Subgroup analyses also showed signifificantly better survival in the absence of distant metastasis (hazard ratio, 0.47; 95% confifidence interval, 0.37-0.60; P<0.001) or local recurrence (hazard ratio, 0.22; 95% confifidence interval, 0.14-0.34; P<0.001) in the matched groups.
Conclusions: Propofol anaesthesia was associated with better survival in hepato- cellular carcinoma patients who underwent hepatectomy. Prospective studies are warranted to evaluate the effects of propofol anaesthesia on surgical outcomes in hepatocellular carcinoma patients.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：代东君 编辑：何幼芹 审校：王贵龙