Nakamura Mashio, Kamei Masataka, Bito Seiji, Migita Kiyoshi, Miyata Shigeki, Kumagai Kenji, Abe Isao, Nakagawa Yasuaki, Nakayama Yuichiro, Saito Masanobu, Tanaka Takaaki, Motokawa Satoru
Japanese National Hospital Organization-EBM Study Group, Japanese Study of Prevention and Actual Situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), Japanese National Hospital Organization Department of Cardiology and Nephrology, Mie University Graduate School of Medicine Center for Pulmonary Embolism and Venous Thrombosis, Murase Hospital Department of Clinical Anesthesiology, Mie University Graduate School of Medicine Division of Clinical Epidemiology, Japanese National Hospital Organization Tokyo Medical Center Department of Rheumatology, Fukushima Medical University Division of Transfusion Medicine, National Cerebral and Cardiovascular Center, Japan.
Medicine (Baltimore). 2017 May;96(18):e6748. doi: 10.1097/MD.0000000000006748.
Clinical guidance on the choice of anesthetic modality vis-à-vis the risk of perioperative venous thromboembolism (VTE) is largely lacking because of a paucity of recent evidence. A comparative effect of general anesthesia and neuraxial blockade on the perioperative incidence of VTE has not been well-investigated.We compared the effects of different types of anesthetic modalities on the risk of VTE after total hip arthroplasty (THA) and total knee arthroplasty (TKA).This is a secondary analysis of the Japanese Study of Prevention and Actual Situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT). Data pertaining to a total of 2162 patients who underwent THA and TKA at 34 hospitals were included in this analysis. We compared the different anesthetic modalities with respect to the incidence of VTE. The composite end-point was asymptomatic/symptomatic deep vein thrombosis detected using scheduled bilateral ultrasonography up to postoperative day (POD) 10 and fatal/non-fatal pulmonary embolism up to POD 10.The study groups were as follows: general anesthesia (n = 646), combined epidural/general anesthesia (n = 1004), epidural anesthesia (n = 87), and spinal anesthesia (n = 425). On multivariate analysis, only spinal anesthesia was associated with a significant increase in the risk of VTE as compared with that associated with general anesthesia. Propensity score-matched analysis for "combined epidural/general anesthesia group" versus "spinal anesthesia group" demonstrated a 48% higher incidence of VTE (relative risk = 1.48, 95% confidence interval [CI] 1.18-1.85) in the latter.Spinal anesthesia was associated with a higher risk of postoperative VTE, as compared with that associated with combined epidural/general anesthesia, in patients undergoing total arthroplasty.
由于近期证据匮乏，关于针对围手术期静脉血栓栓塞症（VTE）风险选择麻醉方式的临床指南基本缺失。全身麻醉和神经阻滞对围手术期VTE发生率的比较影响尚未得到充分研究。我们比较了不同类型麻醉方式对全髋关节置换术（THA）和全膝关节置换术（TKA）后VTE风险的影响。这是对日本全关节置换术后静脉血栓栓塞症预防与实际情况研究（J-PSVT）的二次分析。本分析纳入了34家医院共2162例行THA和TKA的患者数据。我们比较了不同麻醉方式的VTE发生率。复合终点为术后第10天前通过定期双侧超声检查检测到的无症状/有症状深静脉血栓形成以及术后第10天前的致命/非致命肺栓塞。研究组如下：全身麻醉（n = 646）、硬膜外/全身联合麻醉（n = 1004）、硬膜外麻醉（n = 87）和脊髓麻醉（n = 425）。多因素分析显示，与全身麻醉相比，仅脊髓麻醉与VTE风险显著增加相关。“硬膜外/全身联合麻醉组”与“脊髓麻醉组”的倾向评分匹配分析表明，后者的VTE发生率高48%（相对风险 = 1.48，95%置信区间[CI] 1.18 - 1.85）。在接受全关节置换术的患者中，与硬膜外/全身联合麻醉相比，脊髓麻醉与术后VTE风险更高相关。
