非阿片类麻醉对心脏手术术后期的影响：一项回顾性匹配病例对照研究。
Effect of opioid-free anaesthesia on post-operative period in cardiac surgery: a retrospective matched case-control study.
机构信息
Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, 21000, Dijon, France.
出版信息
BMC Anesthesiol. 2019 Jul 31;19(1):136. doi: 10.1186/s12871-019-0802-y.
BACKGROUND
No study has been conducted to demonstrate the feasibility of an opioid-free anesthesia (OFA) protocol in cardiac surgery to improve patient care. The aim of the present study was to evaluate the effect of OFA on post-operative morphine consumption and the post-operative course.
METHODS
After retrospectively registering to clinicaltrial.gov (NCT03816592), we performed a retrospective matched cohort study (1:1) on cardiac surgery patients with cardiopulmonary bypass between 2018 and 2019. Patients were divided into two groups: OFA (lidocaine, dexamethasone and ketamine) or opioid anaesthesia (OA) (sufentanil). The main outcome was the total postoperative morphine consumption in the 48 h after surgery. Secondary outcomes were rescue analgesic use, a major adverse event composite endpoint, and ICU and hospital length of stay (LOS).
RESULTS
One hundred ten patients were matched (OFA: n = 55; OA: n = 55). On inclusion, demographic and surgical data for the OFA and OA groups were comparable. The total morphine consumption was higher in the OA group than in the OFA group (15 (6-34) vs 5 mg (2-18), p = 0.001). The pain score during the first 48 post-operative hours did not differ between the two groups. Creatinine values did not differ on the first post-operative day (80 (IQR: 66-115) vs 77 mmol/l (IQR: 69-95), p = 0.284). Incidence of the composite endpoint was lower in the OFA group (25 patients (43%) vs 38 patients (68%), p = 0.021). The time to extubation and the ICU stays were shorter in the OFA group (3 (1-5) vs 5 (3-6) hours, p = 0.001 and 2 (1-3) vs 3 (2-5) days, p = 0.037).
CONCLUSION
The use of OFA was associated with lower morphine consumption. OFA might be associated with shorter intubation time and ICU stays. Further randomized studies are needed to confirm these results.
TRIAL REGISTRATION
This study was retrospectively registered to ct2 (identifier: NCT03816592 ) on January 25, 2019.
背景
目前还没有研究证明心脏手术中无阿片类麻醉（OFA）方案在改善患者护理方面的可行性。本研究旨在评估 OFA 对术后吗啡消耗和术后过程的影响。
方法
在向 clinicaltrial.gov（NCT03816592）进行回顾性注册后，我们对 2018 年至 2019 年期间接受体外循环心脏手术的患者进行了回顾性 1:1 匹配队列研究。患者分为两组：OFA（利多卡因、地塞米松和氯胺酮）或阿片类麻醉（OA）（舒芬太尼）。主要结局是术后 48 小时内的总术后吗啡消耗量。次要结局是解救性镇痛使用、主要不良事件复合终点以及 ICU 和住院时间（LOS）。
结果
共匹配了 110 例患者（OFA：n=55；OA：n=55）。纳入时，OFA 和 OA 组的人口统计学和手术数据相当。OA 组的总吗啡消耗量高于 OFA 组（15（6-34）vs 5mg（2-18），p=0.001）。两组在术后 48 小时内的疼痛评分无差异。第 1 天的肌酐值无差异（80（IQR：66-115）vs 77mmol/l（IQR：69-95），p=0.284）。OFA 组复合终点发生率较低（25 例（43%）vs 38 例（68%），p=0.021）。OFA 组的拔管时间和 ICU 住院时间较短（3（1-5）vs 5（3-6）小时，p=0.001 和 2（1-3）vs 3（2-5）天，p=0.037）。
结论
使用 OFA 与吗啡消耗减少有关。OFA 可能与缩短插管时间和 ICU 住院时间有关。需要进一步的随机研究来证实这些结果。
试验注册
本研究于 2019 年 1 月 25 日向 ct2（标识符：NCT03816592）进行了回顾性注册。
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