麻醉药物对成人患者心脏术后肺部并发症的影响

Effects of anesthetics on postoperative pulmonary complications in patients undergoing cardiac surgery

目的评估术中麻醉维持药物(吸入麻醉药或静脉麻醉药)对体外循环下成人心脏手术患者术后肺部并发症(postoperative pulmonary complications,PPCs)的影响。方法从四川大学华西医院电子病历信息管理系统及麻醉手术临床信息系统中回顾性筛选2018年9月至2019年2月194例行择期体外循环下心脏手术的成人患者,其中男92例、女102例,平均年龄53岁。根据麻醉维持期间(包括体外循环)使用的麻醉药物进行分组:吸入麻醉组94例(仅使用七氟烷或地氟烷为主的吸入麻醉患者)和静脉麻醉组100例(静脉输注丙泊酚为主的全凭静脉麻醉患者)。主要结局指标是术后7 d PPCs发生率。次要结局指标包括再次气管插管率、术后机械通气时间、ICU停留时间、住院时间。结果共94例(48.5%)患者发生了PPCs。吸入麻醉组发生率为48.9%,静脉麻醉组发生率为48.0%,两组差异无统计学意义(RR=1.020,95%CI 0.763~1.363,P=0.896),并且两组患者次要结局指标差异无统计学意义(P>0.05)。结论对于体外循环下成人心脏手术患者,术中麻醉维持药物(吸入麻醉药或静脉麻醉药)的选择不影响PPCs发生。

Objective To evaluate the association of anesthesia regime(volatile or intravenous anesthetics)with the occurrence of postoperative pulmonary complications(PPCs)in adult patients undergoing elective cardiac surgery under cardiopulmonary bypass(CPB).Methods The electronic medical records of 194 patients undergoing elective cardiac surgery under CPB at West China Hospital,Sichuan University between September 2018 and February 2019 were reviewed,including 92 males and 102 females with an average age of 53 years.The patients were classified into a volatile group(n=94)or a total intravenous anesthesia(TIVA)group(n=100)according to anesthesia regimen during surgery(including CPB).The primary outcome was the incidence of PPCs within first 7 d after surgery.Secondary outcomes included incidence of reintubation,duration of mechanical ventilation,ICU stay and hospital stay.Results There was no significant difference in the incidence of PPCs between the two groups(RR=1.020,95%CI 0.763-1.363,P=0.896),with an incidence of 48.9%in the volatile group and 48.0%in the TIVA group.Secondary outcomes were also found no significant difference between the two groups(P>0.05).Conclusion No association of anesthesia regimen with the incidence of PPCs is found in adult patients undergoing elective cardiac surgery under CPB.