加拿大渥太华大学和渥太华医院Daniel I McIsaac团队比较了在成人下肢血管重建术中进行神经轴索麻醉或全身麻醉对患者预后的影响。2020年11月25日，该研究发表在《英国医学杂志》上。

为了评估神经轴索麻醉或全身麻醉应用于成人下肢血管重建术与临床结局、住院时长以及再入院率之间的相关性，2002年4月1日至2015年3月31日，研究组在加拿大安大略省进行了一项经验证的、基于人群、比较有效性的研究，共招募了20988名年龄在18岁以上的本地居民，在每年进行50次及以上手术的医院中进行了初次下肢血运重建手术。主要结局为30天内的全因死亡，次要结局是院内心肺和肾脏并发症、住院时间和30天内再次入院率。

20988名患者中有6453名（30.7％）接受了神经轴索麻醉，14535名（69.3％）接受了全身麻醉。所研究的医院中，使用神经轴索麻醉的百分比范围为0.6％至90.6％不等。但在研究期间，神经轴索麻醉的使用率下降了17％。神经轴索麻醉组中有204位患者（3.2％）在30天内死亡，全身麻醉组中有646位患者（4.4％）。经过多变量、多级校正后，与全身麻醉相比，采用神经轴索麻醉可显著降低30天死亡率。与全身麻醉相比，使用神经轴索麻醉还可以减少院内心肺和肾脏并发症的几率，缩短住院时间 。

研究结果表明，在下肢血管重建手术中使用神经轴索麻醉，与全身麻醉相比，可显著减少30天死亡率，缩短住院时间。

附：英文原文

Title: Association between neuraxial anaesthesia or general anaesthesia for lower limb revascularisation surgery in adults and clinical outcomes: population based comparative effectiveness study

Author: Derek J Roberts, Sudhir K Nagpal, Dalibor Kubelik, Timothy Brandys, Henry T Stelfox, Manoj M Lalu, Alan J Forster, Colin JL McCartney, Daniel I McIsaac

Issue&Volume: 2020/11/25

Abstract:

Objective To examine the associations between neuraxial anaesthesia or general anaesthesia and clinical outcomes, length of hospital stay, and readmission in adults undergoing lower limb revascularisation surgery.

Design Comparative effectiveness study using linked, validated, population based databases.

Setting Ontario, Canada, 1 April 2002 to 31 March 2015.

Participants 20988 patients Ontario residents aged 18 years or older who underwent their first lower limb revascularisation surgery in hospitals performing 50 or more of these surgeries annually.

Main outcome measures Primary outcome was 30 day all cause mortality. Secondary outcomes were in-hospital cardiopulmonary and renal complications, length of hospital stay, and 30 day readmissions. Multivariable, mixed effects regression models, adjusting for patient, procedural, and hospital characteristics, were used to estimate associations between anaesthetic technique and outcomes. Robustness of analyses were evaluated by conducting instrumental variable, propensity score matched, and survival sensitivity analyses.

Results Of 20988 patients who underwent lower limb revascularisation surgery, 6453 (30.7%) received neuraxial anaesthesia and 14535 (69.3%) received general anaesthesia. The percentage of neuraxial anaesthesia use ranged from 0.6% to 90.6% across included hospitals. Furthermore, use of neuraxial anaesthesia declined by 17% over the study period. Death within 30 days occurred in 204 (3.2%) patients who received neuraxial anaesthesia and 646 (4.4%) patients who received general anaesthesia. After multivariable, multilevel adjustment, use of neuraxial anaesthesia compared with use of general anaesthesia was associated with decreased 30 day mortality (absolute risk reduction 0.72%, 95% confidence interval 0.65% to 0.79%; odds ratio 0.68, 95% confidence interval 0.57 to 0.83; number needed to treat to prevent one death=139). A similar direction and magnitude of association was found in instrumental variable, propensity score matched, and survival analyses. Use of neuraxial anaesthesia compared with use of general anaesthesia was also associated with decreased in-hospital cardiopulmonary and renal complications (odds ratio 0.73, 0.63 to 0.85) and a reduced length of hospital stay (0.5 days, 0.3 to0.6 days).

Conclusions Use of neuraxial anaesthesia compared with general anaesthesia for lower limb revascularisation surgery was associated with decreased 30 day mortality and hospital length of stay. These findings might have been related to reduced cardiopulmonary and renal complications after neuraxial anaesthesia and support the increased use of neuraxial anaesthesia in patients undergoing these surgeries until the results of a large, confirmatory randomised trial become available.

DOI: 10.1136/bmj.m4104

Source: https://www.bmj.com/content/371/bmj.m4104