Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; School of Medicine, University of Liverpool, Liverpool, United Kingdom.
Department of Surgery, Scunthorpe General Hospital, Scunthorpe, United Kingdom.
J Cardiothorac Vasc Anesth. 2020 Apr;34(4):1051-1059. doi: 10.1053/j.jvca.2019.07.007. Epub 2019 Jul 6.
The purpose of this systematic review was to assess the perioperative clinical outcomes in using local/regional anesthesia (LA/RA) or general anesthesia (GA) in patients undergoing endovascular abdominal aortic aneurysm repair. A comprehensive electronic literature search was undertaken from inception to September 2018, identifying all randomized and nonrandomized studies comparing LA/RA versus GA in patients with abdominal aortic aneurysm who underwent endovascular repair. A total of 12,024 patients (n = 1,664 LA/RA, n = 10,360 GA) were analyzed from 12 observational studies included in this analysis. No difference in mean age between LA/RA and GA group was noted (73.8 ± 7.8 y v 72.4 ± 7.6 y, 95% confidence interval 0.85 [-0.08 to 1.79]; p = 0.07). No differences in preoperative rate of chronic obstructive pulmonary disease, ischemic heart disease, diabetes mellitus, and American Society of Anesthesiologists grades were noted between the 2 groups (p = 0.21, p = 0.85, p = 0.46, and p = 0.67, respectively). Shorter total surgical time in LA/RA patients was reported (135 ± 40 min v 164 ± 43 min; p < 0.00001). Shorter hospital stay was observed in LA/RA patients (3.6 ± 3.3 d v 4.6 ± 5 d; p = 0.002). No difference in cardiac or renal complications was noted between the LA/RA and GA groups postoperatively (2.7% v 2.5%; p = 0.46 and 1.2% v 1.6%; p = 0.13). Similarly, no difference in vascular complications was noted in LA/RA versus GA patients (8.4% v 7.7%; p = 0.44). Thirty-day morality was not different between the 2 cohorts (2% v 1.7%; p = 0.97). Use of LA/RA in selective endovascular abdominal aortic aneurysm repair procedures provides satisfactory and comparable perioperative outcomes with those of GA, with the advantage of a shorter hospital stay. A large randomized controlled trial or multicenter study is required to confirm the present study's findings.
本系统评价的目的是评估在接受血管内腹主动脉瘤修复的患者中使用局部/区域麻醉（LA/RA）或全身麻醉（GA）的围手术期临床结果。从 2018 年 9 月开始进行了全面的电子文献检索，以确定所有比较 LA/RA 与 GA 在接受血管内修复的腹主动脉瘤患者中的随机和非随机研究。本分析共纳入了 12 项观察性研究，共分析了 12024 例患者（LA/RA 组 n=1664，GA 组 n=10360）。LA/RA 组和 GA 组的平均年龄无差异（73.8±7.8 岁 v 72.4±7.6 岁，95%置信区间 0.85[-0.08 至 1.79]；p=0.07）。两组之间的慢性阻塞性肺疾病、缺血性心脏病、糖尿病和美国麻醉医师协会分级的术前发生率无差异（p=0.21，p=0.85，p=0.46 和 p=0.67）。LA/RA 患者的总手术时间更短（135±40 分钟 v 164±43 分钟；p<0.00001）。LA/RA 患者的住院时间更短（3.6±3.3 天 v 4.6±5 天；p=0.002）。术后 LA/RA 组和 GA 组的心脏或肾脏并发症无差异（2.7%v2.5%；p=0.46 和 1.2%v1.6%；p=0.13）。同样，LA/RA 与 GA 患者的血管并发症无差异（8.4%v7.7%；p=0.44）。两组 30 天死亡率无差异（2%v1.7%；p=0.97）。在选择性血管内腹主动脉瘤修复手术中使用 LA/RA 可提供与 GA 相似的令人满意的围手术期结果，且具有住院时间更短的优势。需要进行大型随机对照试验或多中心研究来证实本研究的结果。
