De Virgilio Christian, Romero Lina, Donayre Carlos, Meek Kelly, Lewis Roger J, Lippmann Maurice, Rodriguez Christian, White Rodney
Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA 90509, USA.
J Vasc Surg. 2002 Nov;36(5):988-91. doi: 10.1067/mva.2002.128314.
The purpose of this study was to compare the cardiopulmonary morbidity and mortality rates after endovascular abdominal aortic aneurysm (EAAA) repair with local anesthesia (LA) with intravenous sedation versus general anesthesia (GA).
Data from patients who underwent elective infrarenal EAAA repair between June 1996 and October 2000 were retrospectively reviewed. Patients with two or more Eagle clinical cardiac risk factors were considered to be at increased risk for a major postoperative cardiac event. Univariate and multivariate analyses for major cardiac and pulmonary morbidity and mortality rates were analyzed with respect to anesthetic type (GA versus LA), age, size of aneurysm, mean number of Eagle risk factors, and presence of two or more cardiac risk factors.
Two hundred twenty-nine patients underwent EAAA repair. The GA (158 patients) and LA (71 patients) groups were significantly different with respect to mean age (73 versus 76 years; P =.01) and mean number of cardiac risk factors per patient (1.2 versus 1.6; P =.002). No difference was seen in the overall cardiopulmonary complication rate (13% for GA and 19% for LA; P =.3), pulmonary complication rate (3.8% for GA and 7% for LA; P =.3), or cardiopulmonary mortality rate (3.2% for GA and 2.8% for LA; P =.9). The major cardiac event rate was higher in patients with two or more Eagle risk factors (22%) versus those patients with one or less Eagle risk factors (3.4%; P <.001), irrespective of anesthetic type. In analysis of patients with one or less Eagle risk factors, no difference was seen in the major cardiac event rate by anesthetic type (3% for GA and 5% for LA; P =.6). Also, no difference was seen in major cardiac events in patients with two or more Eagle risk factors by anesthetic type (24% for GA and 22% for LA). On multivariate analysis, the mean number of Eagle risk factors per patient (P <.0001) and the presence of two or more Eagle risk factors were associated with major cardiac and cardiopulmonary complications, whereas age, size of AAA, and anesthetic type were not.
No difference exists in overall cardiac and pulmonary morbidity and mortality rates after EAAA repair in comparison of GA and LA. The presence of two or more preoperative cardiac risk factors significantly increases the risk of a major postoperative cardiac event.
本研究旨在比较局部麻醉（LA）联合静脉镇静与全身麻醉（GA）下行血管腔内腹主动脉瘤（EAAA）修复术后的心肺发病率和死亡率。
回顾性分析1996年6月至2000年10月期间接受择期肾下EAAA修复术患者的数据。有两个或更多Eagle临床心脏危险因素的患者被认为术后发生重大心脏事件的风险增加。对主要心脏和肺部发病率及死亡率进行单因素和多因素分析，分析内容包括麻醉类型（GA与LA）、年龄、动脉瘤大小、Eagle危险因素的平均数量以及是否存在两个或更多心脏危险因素。
229例患者接受了EAAA修复术。GA组（158例患者）和LA组（71例患者）在平均年龄（73岁对76岁；P = 0.01）和每位患者心脏危险因素的平均数量（1.2对1.6；P = 0.002）方面存在显著差异。总体心肺并发症发生率（GA组为13%，LA组为19%；P = 0.3）、肺部并发症发生率（GA组为3.8%，LA组为7%；P = 0.3）或心肺死亡率（GA组为3.2%，LA组为2.8%；P = 0.9）均无差异。有两个或更多Eagle危险因素的患者主要心脏事件发生率（22%）高于有一个或更少Eagle危险因素的患者（3.4%；P < 0.001），与麻醉类型无关。在对有一个或更少Eagle危险因素的患者进行分析时，不同麻醉类型的主要心脏事件发生率无差异（GA组为3%，LA组为5%；P = 0.6）。同样，在有两个或更多Eagle危险因素的患者中，不同麻醉类型的主要心脏事件发生率也无差异（GA组为24%，LA组为22%）。多因素分析显示，每位患者Eagle危险因素的平均数量（P < 0.0001）以及存在两个或更多Eagle危险因素与主要心脏和心肺并发症相关，而年龄、腹主动脉瘤大小和麻醉类型则无关。
GA和LA用于EAAA修复术后，总体心脏和肺部发病率及死亡率无差异。术前存在两个或更多心脏危险因素会显著增加术后发生重大心脏事件的风险。
