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术后硬膜外镇痛对非小细胞肺癌患者无复发生存率和总生存率的影响。

Effects of postoperative epidural analgesia on recurrence-free and overall survival in patients with nonsmall cell lung cancer.

作者信息

Cata Juan P, Gottumukkala Vijaya, Thakar Dilip, Keerty Dinesh, Gebhardt Rodolfo, Liu Diane D

机构信息

Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.

Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.

出版信息

J Clin Anesth. 2014 Feb;26(1):3-17. doi: 10.1016/j.jclinane.2013.06.007. Epub 2013 Oct 4.

Abstract

STUDY OBJECTIVE

To determine whether postoperative epidural analgesia is associated with better recurrence-free survival and overall survival after lung cancer surgery.

DESIGN

Retrospective study.

SETTING

Academic hospital.

MEASUREMENTS

Data of patients with stage 1, stage 2, and stage 3 nonsmall cell lung cancer, who underwent tumor resection surgery, were studied. Patient data were grouped into three different postoperative pain management interventions: intravenous patient-controlled analgesia, patient-controlled epidural analgesia, and their combination. Univariate and multicovariate Cox proportional hazards models were applied to assess the effects of covariates of interest on overall survival and recurrence-free survival.

MAIN RESULTS

The type of postoperative analgesia used for patients who underwent surgery for nonsmall cell lung cancer did not affect recurrence-free survival or overall survival. However, certain variables, including age ≥ 65 years, male gender, body mass index ≥ 25 kg/m(2), ASA physical status 4, and the need for preoperative blood transfusions, pneumonectomy, and postoperative radiation, were associated with decreased recurrence-free survival and overall survival.

CONCLUSIONS

The type of postoperative analgesia used after surgery for nonsmall cell lung cancer is not associated with better 2-year or 5-year recurrence-free survival or overall survival rates.

摘要

研究目的

确定肺癌手术后硬膜外镇痛是否与更好的无复发生存率和总生存率相关。

设计

回顾性研究。

地点

教学医院。

测量

对接受肿瘤切除手术的Ⅰ期、Ⅱ期和Ⅲ期非小细胞肺癌患者的数据进行研究。患者数据被分为三种不同的术后疼痛管理干预措施:静脉自控镇痛、硬膜外自控镇痛及其联合使用。应用单因素和多因素Cox比例风险模型评估感兴趣的协变量对总生存率和无复发生存率的影响。

主要结果

接受非小细胞肺癌手术患者所使用的术后镇痛类型不影响无复发生存率或总生存率。然而,某些变量,包括年龄≥65岁、男性、体重指数≥25kg/m²、美国麻醉医师协会身体状况分级为4级,以及术前输血、全肺切除术和术后放疗的需求,与无复发生存率和总生存率降低相关。

结论

非小细胞肺癌手术后使用的术后镇痛类型与更好的2年或5年无复发生存率或总生存率无关。

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