Brighton and Sussex University Hospitals NHS Trust, Brighton, East Sussex, UK.
Anaesthesia and Critical Care Section, Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Anaesthesia. 2016 May;71(5):506-14. doi: 10.1111/anae.13415. Epub 2016 Mar 4.
We re-analysed prospective data collected by anaesthetists in the Anaesthesia Sprint Audit of Practice (ASAP-1) to describe associations with linked outcome data. Mortality was 165/11,085 (1.5%) 5 days and 563/11,085 (5.1%) 30 days after surgery and was not associated with anaesthetic technique (general vs. spinal, with or without peripheral nerve blockade). The risk of death increased as blood pressure fell: the odds ratio (95% CI) for mortality within five days after surgery was 0.983 (0.973-0.994) for each 5 mmHg intra-operative increment in systolic blood pressure, p = 0.0016, and 0.980 (0.967-0.993) for each mmHg increment in mean pressure, p = 0.0039. The equivalent odds ratios (95% CI) for 30-day mortality were 0.968 (0.951-0.985), p = 0.0003 and 0.976 (0.964-0.988), p = 0.0001, respectively. The lowest systolic blood pressure after intrathecal local anaesthetic relative to before induction was weakly correlated with a higher volume of subarachnoid bupivacaine: r(2) -0.10 and -0.16 for hyperbaric and isobaric bupivacaine, respectively. A mean 20% relative fall in systolic blood pressure correlated with an administered volume of 1.44 ml hyperbaric bupivacaine. Future research should focus on refining standardised anaesthesia towards administering lower doses of spinal (and general) anaesthesia and maintaining normotension.
我们重新分析了麻醉师在实践中的快速麻醉评估（ASAP-1）中收集的前瞻性数据，以描述与关联结果数据的关系。术后 5 天和 30 天的死亡率分别为 165/11085（1.5%）和 563/11085（5.1%），与麻醉技术（全身麻醉与脊髓麻醉，有无周围神经阻滞）无关。血压下降与死亡风险增加相关：术后 5 天内死亡率的比值比（95%CI），每增加 5mmHg 术中收缩压增加 0.983（0.973-0.994），p=0.0016，平均压每增加 1mmHg 增加 0.980（0.967-0.993），p=0.0039。30 天死亡率的等效比值比（95%CI）分别为 0.968（0.951-0.985），p=0.0003 和 0.976（0.964-0.988），p=0.0001。鞘内局部麻醉后与诱导前相比，收缩压最低与蛛网膜下腔布比卡因体积较大相关：布比卡因分别为 0.10 和 -0.16。收缩压平均下降 20%与给予的 1.44ml 布比卡因高度相关。未来的研究应侧重于通过给予较低剂量的脊髓（和全身）麻醉和维持正常血压来完善标准化麻醉。
