根治性切除术后中老年食管癌患者强化或标准体温管理对术后心肌损伤的影响：一项随机对照试验。

Postoperative Myocardial Injury in Middle-Aged and Elderly Patients Following Curative Resection of Esophageal Cancer With Aggressive or Standard Body Temperature Management: A Randomized Controlled Trial.

机构信息

From the Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.

出版信息

Anesth Analg. 2019 Aug;129(2):352-359. doi: 10.1213/ANE.0000000000004022.

DOI:10.1213/ANE.0000000000004022

PMID:30676350

Abstract

BACKGROUND

Risk of intraoperative hypothermia is relatively high in middle-aged and elderly patients undergoing curative resection of esophageal cancer, which may cause myocardial ischemia during the early postoperative period. The objective of this study was to compare aggressive or standard body temperature management for lowering the incidence of postoperative myocardial injury that was assessed by troponin levels collected at a priori defined set times in these patients.

METHODS

Seventy patients undergoing elective curative resection of esophageal cancer were randomly assigned to undergo aggressive body temperature management (nasopharyngeal temperature ≥36°C) or standard body temperature management (n = 35 in each arm). The primary outcome was myocardial injury, defined as the occurrence of elevated troponin I (>0.06 µg/L) or elevated high-sensitivity troponin T (≥0.065, or 0.02 µg/L≤ high-sensitivity troponin T <0.065 µg/L, but with an absolute change of at least 0.005 µg/L) or both during 2 days after surgery. Secondary outcomes included (1) severe arrhythmia, including atrial fibrillation, supraventricular tachycardia, frequent premature ventricular contractions intraoperatively or during 3 days postoperatively; (2) hypoxemia or metabolic acidosis during the first 12 h postoperatively; and (3) deep vein thrombosis or pulmonary embolism during 3 days postoperatively.

RESULTS

Incidence of postoperative 2-day myocardial injury was 8.6% (3/35) among patients receiving aggressive body temperature management and 31.4% (11/35) among patients receiving standard body temperature management (P = .017, χ). Relative risk of myocardial injury in the aggressive body temperature management group was 0.27 (95% CI, 0.08-0.89). Incidence of intra- and postoperative 3-day severe cardiac arrhythmia was 2.9% (1/35) among patients receiving aggressive body temperature management and 28.6% (10/35) among patients receiving standard body temperature management. Incidence of postoperative 12-h hypoxia was 17.1% (6/35) with aggressive body temperature management and 40.0% (14/35) with standard body temperature management. Incidence of postoperative 12-h metabolic acidosis was 20% (7/35) among patients receiving aggressive body temperature management and 48.6% (17/35) among patients receiving standard body temperature management. Incidence of postoperative 3-day deep vein thrombosis or pulmonary embolism was 0% (0/35) with aggressive body temperature management and 2.9% (1/35) with standard body temperature management.

CONCLUSIONS

Aggressive body temperature management may be associated with a lower incidence of postoperative myocardial injury.

摘要

背景

接受根治性食管癌切除术的中老年患者术中发生低体温的风险相对较高，这可能导致术后早期发生心肌缺血。本研究的目的是比较积极或标准的体温管理，以降低这些患者在预先设定的时间点采集的肌钙蛋白水平评估的术后心肌损伤的发生率。

方法

70 例择期接受根治性食管癌切除术的患者被随机分配接受积极的体温管理（鼻咽温度≥36°C）或标准体温管理（每组 35 例）。主要结局是心肌损伤，定义为术后 2 天内肌钙蛋白 I 升高（>0.06 µg/L）或高敏肌钙蛋白 T 升高（≥0.065，或 0.02 µg/L≤高敏肌钙蛋白 T <0.065 µg/L，但绝对变化至少 0.005 µg/L）或两者同时升高。次要结局包括（1）术后 2 天内严重心律失常，包括心房颤动、室上性心动过速、术中或术后 3 天内频发室性早搏；（2）术后 12 小时内低氧血症或代谢性酸中毒；（3）术后 3 天内深静脉血栓形成或肺栓塞。

结果

积极体温管理组术后 2 天心肌损伤发生率为 8.6%（3/35），标准体温管理组为 31.4%（11/35）（P=0.017， χ ）。积极体温管理组心肌损伤的相对风险为 0.27（95%CI，0.08-0.89）。积极体温管理组和标准体温管理组术中及术后 3 天严重心脏心律失常的发生率分别为 2.9%（1/35）和 28.6%（10/35）。积极体温管理组术后 12 小时低氧血症的发生率为 17.1%（6/35），标准体温管理组为 40.0%（14/35）。积极体温管理组术后 12 小时代谢性酸中毒的发生率为 20%（7/35），标准体温管理组为 48.6%（17/35）。积极体温管理组术后 3 天深静脉血栓形成或肺栓塞的发生率为 0%（0/35），标准体温管理组为 2.9%（1/35）。