Lohse N, Lundstrøm L H, Vestergaard T R, Risom M, Rosenstock S J, Foss N B, Møller M H
Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Hvidovre, Kettegaards Alle 30, DK-2650 Hvidovre, Denmark
Department of Anaesthesiology and Intensive Care Medicine, Nordsjællands Hospital, Copenhagen University Hospital, Hillerød, Dyrehave 29, DK-3400 Hillerød, Denmark.
Br J Anaesth. 2015 Jun;114(6):901-8. doi: 10.1093/bja/aev100. Epub 2015 May 2.
Emergency upper gastrointestinal bleeding is a common condition with high mortality. Most patients undergo oesophagogastroduodenoscopy (OGD), but no universally agreed approach exists to the type of airway management required during the procedure. We aimed to compare anaesthesia care with tracheal intubation (TI group) and without airway instrumentation (monitored anaesthesia care, MAC group) during emergency OGD.
This was a prospective, nationwide, population-based cohort study during 2006-13. Emergency OGDs performed under anaesthesia care were included. End points were 90 day mortality (primary) and length of stay in hospital (secondary). Associations between exposure and outcomes were assessed in logistic and linear regression models, adjusted for the following potential confounders: shock at admission, level of anaesthetic expertise present, ASA score, Charlson comorbidity index score, BMI, age, sex, alcohol use, referral origin (home or in-hospital), Forrest classification, ulcer localization, and postoperative care.
The study group comprised 3580 patients under anaesthesia care: 2101 (59%) for the TI group and 1479 (41%) for the MAC group. During the first 90 days after OGD, 18.9% in the TI group and 18.4% in the MAC group died, crude odds ratio=1.03 [95% confidence interval (CI)=0.87-1.23, P=0.701], adjusted odds ratio=0.95 (95% CI=0.79-1.15, P=0.590). Patients in the TI group stayed slightly longer in hospital [mean 8.16 (95% CI=7.63-8.60) vs 7.63 days (95%=CI 6.92-8.33), P=0.108 in adjusted analysis].
In this large population-based cohort study, anaesthesia care with TI was not different from anaesthesia care without airway instrumentation in patients undergoing emergency OGD in terms of 90 day mortality and length of hospital stay.
急诊上消化道出血是一种常见疾病，死亡率高。大多数患者接受食管胃十二指肠镜检查（OGD），但对于检查过程中所需的气道管理类型，尚无普遍认可的方法。我们旨在比较急诊OGD期间气管插管麻醉护理（TI组）和无气道器械辅助麻醉护理（监护麻醉护理，MAC组）的效果。
这是一项2006年至2013年期间基于全国人群的前瞻性队列研究。纳入在麻醉护理下进行的急诊OGD病例。终点指标为90天死亡率（主要指标）和住院时间（次要指标）。在逻辑回归和线性回归模型中评估暴露因素与结局之间的关联，并对以下潜在混杂因素进行校正：入院时休克、麻醉专业水平、美国麻醉医师协会（ASA）评分、查尔森合并症指数评分、体重指数（BMI）、年龄、性别、饮酒情况、转诊来源（家庭或住院）、福里斯特分类、溃疡部位以及术后护理。
研究组包括3580例接受麻醉护理的患者：TI组2101例（59%），MAC组1479例（41%）。在OGD后的前90天内，TI组死亡率为18.9%，MAC组为18.4%，粗比值比=1.03[95%置信区间（CI）=0.87 - 1.23，P = 0.701]，校正比值比=0.95（95%CI = 0.79 - 1.15，P = 0.590）。TI组患者住院时间略长[平均8.16天（95%CI = 7.63 - 8.60），而MAC组为7.63天（95%CI = 6.92 - 8.33），校正分析中P = 0.108]。
在这项基于人群的大型队列研究中，对于接受急诊OGD的患者，气管插管麻醉护理与无气道器械辅助麻醉护理在90天死亡率和住院时间方面并无差异。
