丙泊酚全凭静脉麻醉对胃癌的影响：一项回顾性研究。
Effects of propofol-based total intravenous anesthesia on gastric cancer: a retrospective study.
作者信息
Zheng Xiaoyu, Wang Yu, Dong Linlin, Zhao Su, Wang Liping, Chen Hong, Xu Yang, Wang Guonian
机构信息
Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, China.
Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin, China.
出版信息
Onco Targets Ther. 2018 Mar 1;11:1141-1148. doi: 10.2147/OTT.S156792. eCollection 2018.
BACKGROUND
Several kinds of cancer surgeries with propofol-based total intravenous anesthesia (TIVA) have been shown to have better outcomes than those with sevoflurane-based inhalational anesthesia (INHA). However, the effects of this anesthetic technique have not been investigated in patients with gastric cancer. In this study, the authors retrospectively examined the link between the choice of anesthetic technique and overall survival in patients undergoing gastric cancer resection.
METHODS
We conducted a retrospective analysis of the database of all patients undergoing gastric cancer resection for gastric cancer between 2007 and 2012. Patients who received TIVA or INHA were administered patient-controlled intravenous analgesia for 72-120 hours postoperatively. Survival was estimated using the Kaplan-Meier log-rank test, and associations between anesthetic technique and outcomes were analyzed using Cox proportional hazards regressions after propensity matching.
RESULTS
A total of 2,856 anesthetics using INHA or TIVA were delivered in the study period. After propensity matching, 897 patients remained in each group. According to Kaplan-Meier analysis, the use of TIVA was associated with improved survival (<0.001). TIVA was associated with a hazard ratio (HR) of 0.67 (95% confidence interval [CI]: 0.58-0.77) for death in univariate analysis and 0.65 (95% CI: 0.56-0.75) after a multivariate analysis of known confounders in the matched group. Cancer stage (HR =0.74, 95% CI: 0.64-0.86, <0.001) and degree of differentiation (HR =1.28, 95% CI: 1.11-1.47, <0.001) were also associated with survival in the univariate analysis in the matched group. In the multivariable Cox model, cancer stage (HR =0.72, 95% CI: 0.62-0.84, <0.001) and degree of differentiation (HR =1.23, 95% CI: 1.07-1.42, <0.001) were associated with survival in the matched group.
CONCLUSION
These results indicate that TIVA may be associated with improved survival in gastric cancer patients who undergo resection.
背景
多项采用丙泊酚全凭静脉麻醉（TIVA）的癌症手术已显示出比采用七氟醚吸入麻醉（INHA）的手术有更好的预后。然而，这种麻醉技术对胃癌患者的影响尚未得到研究。在本研究中，作者回顾性研究了麻醉技术的选择与接受胃癌切除术患者总生存期之间的联系。
方法
我们对2007年至2012年间所有因胃癌接受胃癌切除术患者的数据库进行了回顾性分析。接受TIVA或INHA的患者术后接受72 - 120小时的患者自控静脉镇痛。使用Kaplan - Meier对数秩检验估计生存期，并在倾向匹配后使用Cox比例风险回归分析麻醉技术与预后之间的关联。
结果
在研究期间共实施了2856例使用INHA或TIVA的麻醉。倾向匹配后，每组各有897例患者。根据Kaplan - Meier分析，使用TIVA与生存期改善相关（<0.001）。在单因素分析中，TIVA与死亡风险比（HR）为0.67（95%置信区间[CI]：0.58 - 0.77），在匹配组中对已知混杂因素进行多因素分析后为0.65（95% CI：0.56 - 0.75）。在匹配组的单因素分析中，癌症分期（HR = 0.74，95% CI：0.64 - 0.86，<0.001）和分化程度（HR = 1.28，95% CI：1.11 - 1.47，<0.001）也与生存期相关。在多变量Cox模型中，癌症分期（HR = 0.72，95% CI：0.62 - 0.84，<0.001）和分化程度（HR = 1.23，95% CI：1.07 - 1.42，<0.001）与匹配组的生存期相关。
结论
这些结果表明，TIVA可能与接受切除术的胃癌患者生存期改善相关。
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