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异丙酚和全吸入麻醉对高危患者无泵心脏手术后心血管结局的比较：一项随机对照试验和可行性研究
贵州医科大学 麻醉与心脏电生理课题组
翻译：王波 编辑：田明德 审校：曹莹
目的：心肌血运重建和体外循环（CPB）可引起缺血再灌注损伤，导致心肌和其他末端器官损伤。实验研究表明，挥发性麻醉剂对心肌有保护作用。然而，由于丙泊酚的联合给药及其有害作用，限制了心肌保护过程，因此这是否转化为临床益处还存在不确定性。
方法：在这项单盲、平行组随机对照可行性试验中，接受选择性冠状动脉旁路移植术（CABG）手术且欧洲心脏手术风险评估系统评分≥5分的高风险患者被随机分组，接受异丙酚或全吸入麻醉作为维持麻醉的单一药物。主要结局是在两个心脏外科中心招募和随机分配50例患者的可行性，次要结局包括收集计划的围手术期数据的可行性、临床相关结局以及有效患者识别、筛选和招募的评估。
结果：所有50名患者都是在11个月内在两个中心招募的，由于COVID-19大流行，招募工作中断了13个月。总体而言，招募了50/108（46%）例合格患者。1例患者在手术前退出，1例患者未接受手术。除1例外，所有患者均在住院期间完成了30天的随访。
结论：招募并随机选择接受冠脉搭桥手术的高危患者，及时比较全吸入麻醉和异丙酚麻醉，并具有较高的接受率和完成率，是可行的。
文献来源：Milne B, John M, Evans R, et al. Comparison between propofol and total inhalational anaesthesia on cardiovascular outcomes following on-pump cardiac surgery in higher-risk patients: a randomised controlled pilot and feasibility study. Open Heart. 2024;11(1):e002630. Published 2024 May 9.
Comparison between propofol and total inhalational anaesthesia on cardiovascular outcomes following on-pump cardiac surgery in higher-risk patients: a randomised controlled pilot and feasibility study
Objectives:Myocardial revascularisation and cardiopulmonary bypass (CPB) can cause ischaemia-reperfusion injury, leading to myocardial and other end-organ damage. Volatile anaesthetics protect the myocardium in experimental studies. However, there is uncertainty about whether this translates into clinical benefits because of the coadministration of propofol and its detrimental effects, restricting myocardial protective processes.
Methods:In this single-blinded, parallel-group randomised controlled feasibility trial, higher-risk patients undergoing elective coronary artery bypass graft (CABG) surgery with an additive European System for Cardiac Operative Risk Evaluation ≥5 were randomised to receive either propofol or total inhalational anaesthesia as single agents for maintenance of anaesthesia. The primary outcome was the feasibility of recruiting and randomising 50 patients across two cardiac surgical centres, and secondary outcomes included the feasibility of collecting the planned perioperative data, clinically relevant outcomes and assessments of effective patient identification, screening and recruitment.
Results:All 50 patients were recruited within 11 months in two centres, allowing for a 13-month hiatus in recruitment due to the COVID-19 pandemic. Overall, 50/108 (46%) of eligible patients were recruited. One patient withdrew before surgery and one patient did not undergo surgery. All but one completed in-hospital and 30-day follow-up.
Conclusions:It is feasible to recruit and randomise higher-risk patients undergoing CABG surgery to a study comparing total inhalational and propofol anaesthesia in a timely manner and with high acceptance and completion rates.
