Tuman K J, McCarthy R J, Spiess B D, DaValle M, Dabir R, Ivankovich A D
Department of Anesthesiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612.
Anesthesiology. 1989 Feb;70(2):189-98. doi: 10.1097/00000542-198902000-00003.
A prospective study of 1094 consecutive adult patients undergoing coronary revascularization was undertaken to determine the effect of anesthetic technique on outcome. Patients received one of five primary techniques: high-dose fentanyl (greater than 50 micrograms/kg), moderate-dose fentanyl (less than 50 micrograms/kg), sufentanil (3-8 micrograms/kg), diazepam (0.4-1 mg/kg) with ketamine (3-6 mg/kg) or halothane (0.5-2.5% inspired concentration after thiopental induction). Supplemental inhalation anesthesia (enflurane, halothane, or isoflurane) was used in 60% of cases where the primary technique was intravenous based. Patients in the above anesthetic groupings had similar perioperative demographic and risk classifications. The overall incidence of postoperative myocardial infarction, postoperative low cardiac output state, and in-hospital death were 4.1, 5.6, and 3.1%, respectively. There were no significant differences in the incidence of these occurrences or in the incidence of serious pulmonary, renal, or neurologic morbidity or length of ICU stay among primary anesthetic techniques nor among supplemental inhalation agent groups. Multivariate discriminant analysis of this data suggests that a multitude of factors are significantly more important than anesthetic technique as determinants of outcome after coronary artery surgery.
对1094例连续接受冠状动脉血运重建的成年患者进行了一项前瞻性研究，以确定麻醉技术对预后的影响。患者接受五种主要技术之一：高剂量芬太尼（大于50微克/千克）、中等剂量芬太尼（小于50微克/千克）、舒芬太尼（3 - 8微克/千克）、地西泮（0.4 - 1毫克/千克）与氯胺酮（3 - 6毫克/千克）合用或氟烷（硫喷妥钠诱导后吸入浓度为0.5 - 2.5%）。在60%以静脉麻醉为主的病例中使用了辅助吸入麻醉（恩氟烷、氟烷或异氟烷）。上述麻醉分组中的患者围手术期人口统计学特征和风险分类相似。术后心肌梗死、术后低心排血量状态和住院死亡的总体发生率分别为4.1%、5.6%和3.1%。这些事件的发生率、严重肺部、肾脏或神经并发症的发生率或重症监护病房住院时间在主要麻醉技术之间以及辅助吸入麻醉剂组之间均无显著差异。对该数据进行多变量判别分析表明，作为冠状动脉手术后预后的决定因素，许多因素比麻醉技术重要得多。
