辅助区域麻醉与单纯全身麻醉术后肺部并发症比较：围手术期研究网络研究的亚分析。

Postoperative pulmonary complications with adjuvant regional anesthesia versus general anesthesia alone: a sub-analysis of the Perioperative Research Network study.

机构信息

Department of Anesthesiology, University of Colorado School of Medicine, 12631 E 17th Ave, AO-1 bldg, R2012, MS 8202, Aurora, CO, 80045, USA.

University of Nebraska Medical Center, Omaha, NE, USA.

出版信息

BMC Anesthesiol. 2022 May 3;22(1):136. doi: 10.1186/s12871-022-01679-5.

DOI:10.1186/s12871-022-01679-5

PMID:35501692

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9063185/

Abstract

BACKGROUND

Adjuvant regional anesthesia is often selected for patients or procedures with high risk of pulmonary complications after general anesthesia. The benefit of adjuvant regional anesthesia to reduce postoperative pulmonary complications remains uncertain. In a prospective observational multicenter study, patients scheduled for non-cardiothoracic surgery with at least one postoperative pulmonary complication surprisingly received adjuvant regional anesthesia more frequently than those with no complications. We hypothesized that, after adjusting for surgical and patient complexity variables, the incidence of postoperative pulmonary complications would not be associated with adjuvant regional anesthesia.

METHODS

We performed a secondary analysis of a prospective observational multicenter study including 1202 American Society of Anesthesiologists physical status 3 patients undergoing non-cardiothoracic surgery. Patients were classified as receiving either adjuvant regional anesthesia or general anesthesia alone. Predefined pulmonary complications within the first seven postoperative days were prospectively identified. Groups were compared using bivariable and multivariable hierarchical logistic regression analyses for the outcome of at least one postoperative pulmonary complication.

RESULTS

Adjuvant regional anesthesia was performed in 266 (22.1%) patients and not performed in 936 (77.9%). The incidence of postoperative pulmonary complications was greater in patients receiving adjuvant regional anesthesia (42.1%) than in patients without it (30.9%) (site adjusted p = 0.007), but this association was not confirmed after adjusting for covariates (adjusted OR 1.37; 95% CI, 0.83-2.25; p = 0.165).

CONCLUSION

After adjusting for surgical and patient complexity, adjuvant regional anesthesia versus general anesthesia alone was not associated with a greater incidence of postoperative pulmonary complications in this multicenter cohort of non-cardiothoracic surgery patients.

摘要

背景

对于全麻后有发生肺部并发症高风险的患者或手术，常选择辅助区域麻醉。辅助区域麻醉降低术后肺部并发症的效果仍不确定。在一项前瞻性观察性多中心研究中，令人惊讶的是，与无并发症的患者相比，术后肺部并发症至少有 1 例的非心胸手术患者更常接受辅助区域麻醉。我们假设，在调整手术和患者复杂程度变量后，术后肺部并发症的发生率与辅助区域麻醉无关。

方法

我们对一项前瞻性观察性多中心研究进行了二次分析，该研究纳入了 1202 名美国麻醉医师协会（ASA）身体状况 3 级行非心胸手术的患者。患者分为接受辅助区域麻醉或单纯全身麻醉。前瞻性地确定术后第 1 至 7 天内的预先定义的肺部并发症。使用二变量和多变量分层逻辑回归分析对至少有 1 例术后肺部并发症的结果比较两组。

结果

266 名（22.1%）患者接受了辅助区域麻醉，936 名（77.9%）患者未接受辅助区域麻醉。接受辅助区域麻醉的患者术后肺部并发症发生率（42.1%）高于未接受辅助区域麻醉的患者（30.9%）（部位校正后 p=0.007），但调整协变量后这种关联未得到证实（校正比值比 1.37；95%CI，0.83-2.25；p=0.165）。