与全身麻醉相比，下肢截肢的区域麻醉与术后并发症减少相关。
Regional Anaesthesia for Lower Extremity Amputation is Associated with Reduced Post-operative Complications Compared with General Anaesthesia.
机构信息
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA.
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA; Department of Anaesthesiology, Düsseldorf University Hospital, Düsseldorf, Germany.
出版信息
Eur J Vasc Endovasc Surg. 2021 Sep;62(3):476-484. doi: 10.1016/j.ejvs.2021.05.040. Epub 2021 Jul 22.
OBJECTIVE
Primary and secondary lower extremity amputation, performed for patients with lower extremity arterial disease, is associated with increased post-operative morbidity. The aim of the study was to assess the impact of regional anaesthesia vs. general anaesthesia on post-operative pulmonary complications.
METHODS
A retrospective analysis of 45 492 patients undergoing lower extremity amputation between 2005 and 2018 was conducted using data from the American College of Surgeons National Safety Quality Improvement Program database. Multivariable logistic regression was carried out to assess differences in primary outcome of post-operative pulmonary complications (pneumonia or respiratory failure requiring re-intubation) within 48 hours and 30 days after surgery between patients receiving regional (RA) or general anaesthesia (GA). Secondary outcomes included post-operative blood transfusion, septic shock, re-operation, and post-operative death within 30 days.
RESULTS
Of 45 492 patients, 40 026 (88.0%) received GA and 5 466 (12.0%) RA. Patients who received GA had higher odds of developing pulmonary complications at 48 hours (2.1% vs. 1.4%; adjusted odds ratio [aOR] 1.39, 95% confidence interval [CI] 1.09 - 1.78; p = .007) and within 30 days (6.3% vs. 5.9%; aOR 1.15, 95% CI 1.09 - 1.78; p = .039). The odds of blood transfusions (aOR 1.11, 95% CI 1.02 - 1.21; p = .017), septic shock (aOR 1.29, 95% CI 1.03 - 1.60; p = .025) and re-operation (OR 1.26, 95% CI 1.03 - 1.53; p = .023) were also higher for patients who received GA vs. patients who received RA. No difference in mortality rate was observed between patients who received GA and those who received RA (5.7% vs. 7.1%; odds ratio 0.95, 95% CI 0.84 - 1.07).
CONCLUSION
A statistically significant reduction in pulmonary complications was observed in patients who received RA for lower extremity amputation compared with GA.
目的
因下肢动脉疾病而进行的下肢主要和次要截肢术与术后发病率增加有关。本研究旨在评估区域麻醉与全身麻醉对术后肺部并发症的影响。
方法
使用美国外科医师学院国家安全质量改进计划数据库中的数据，对 2005 年至 2018 年间进行的 45492 例下肢截肢患者进行回顾性分析。多变量逻辑回归用于评估接受区域麻醉（RA）或全身麻醉（GA）的患者术后 48 小时和 30 天内主要结局（肺炎或需要重新插管的呼吸衰竭）以及术后输血、脓毒症休克、再次手术和 30 天内死亡等次要结局的差异。
结果
在 45492 例患者中，40026 例（88.0%）接受 GA，5466 例（12.0%）接受 RA。接受 GA 的患者在术后 48 小时（2.1%比 1.4%；调整后的优势比 [aOR] 1.39，95%置信区间 [CI] 1.09-1.78；p=0.007）和术后 30 天（6.3%比 5.9%；aOR 1.15，95%CI 1.09-1.78；p=0.039）肺部并发症的发生风险更高。接受 GA 的患者输血（aOR 1.11，95%CI 1.02-1.21；p=0.017）、脓毒症休克（aOR 1.29，95%CI 1.03-1.60；p=0.025）和再次手术（OR 1.26，95%CI 1.03-1.53；p=0.023）的风险也高于接受 RA 的患者。接受 GA 和接受 RA 的患者的死亡率无差异（5.7%比 7.1%；比值比 0.95，95%CI 0.84-1.07）。
结论
与全身麻醉相比，接受下肢截肢术的患者接受 RA 可显著降低肺部并发症发生率。
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