全凭静脉麻醉与吸入麻醉对乳腺癌手术患者预后影响的比较：回顾性队列研究
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
Total Intravenous Anesthesia versus Inhalation Anesthesia for Breast Cancer Surgery ：a retrospective cohort study
背景与目的
麻醉方法与癌症复发之间的关系仍存在争议。本回顾性队列研究比较了全身静脉麻醉和吸入麻醉对乳腺癌术后复发的影响。
方 法
本研究回顾了2005年1月至2013年12月间在三级教学医院接受乳腺癌手术的患者的电子病历。根据手术采用的是静脉麻醉或吸入麻醉进行分组。倾向评分匹配用于解释基线特征的差异。建立Kaplan Meier生存曲线，评估麻醉方法对术后复发时间和总生存率的影响。比较两种麻醉的癌症复发风险和全因死亡率。
结 果
研究期间7678例乳腺癌患者中，有5331例患者资料可供分析，全凭静脉麻醉组，n = 3085; 吸入麻醉组，n = 2246)。经过倾向评分匹配后，每组仍然有1766例患者。Kaplan Meier生存曲线显示两组术后复发时间及总生存率无显著差异，全凭静脉麻醉组术后5年复发情况93.2% (95% CI, 91.9 ~ 94.5)，吸入组术后5年复发情况93.8% (95% CI, 92.6 ~ 95.1)。吸入麻醉与全凭静脉麻醉相比，对术后复发时间(风险比0.96;95% CI, 0.69到1.32;P = 0.782)或总生存率(风险比0.96;95% CI, 0.69 ~ 1.33, P = 0.805)无显著影响。
结 论
本研究发现麻醉方法与乳腺癌的长期预后无差异。
原始文献摘要
Seokha Yoo, Han-Byoel Lee, Wonshik Han；Total Intravenous Anesthesia versus Inhalation Anesthesia for Breast Cancer Surgery：A Retrospective Cohort Study；Anesthesiology 2019; 130:31–40
Background：
The association between type of anesthesia used and recurrence of cancer remains controversial. This retrospective cohort study compared the influence of total IV anesthesia and inhalation anesthesia on the primary outcome of recurrence-free survival after breast cancer surgery.
Methods：
The authors reviewed the electronic medical records of patients who had breast cancer surgery at a tertiary care teaching hospital between January 2005 and December 2013. The patients were grouped according to whether IV or inhalation anesthesia was used for surgery. Propensity score matching was used to account for differences in baseline characteristics. Kaplan Meier survival curves were constructed to evaluate the influence of type of anesthesia on recurrence-free survival and overall survival. The risks of cancer recurrence and all-cause mortality were compared between each type of anesthesia.
Results：
Of 7,678 patients who had breast cancer surgery during the study period, data for 5,331 patients were available for analysis (IV group, n = 3,085; inhalation group, n = 2,246). After propensity score matching, 1,766 patients remained in each group. Kaplan Meier survival curves showed that there was no significant difference in recurrence-free survival or overall survival between the two groups, with 5-yr recurrence-free survival rates of 93.2% (95% CI, 91.9 to 94.5) in the IV group and 93.8% (95% CI, 92.6 to 95.1) in the inhalation group. Inhalation anesthesia had no significant impact on recurrence-free survival (hazard ratio, 0.96; 95% CI, 0.69 to 1.32; P = 0.782) or overall survival (hazard ratio, 0.96; 95% CI, 0.69 to 1.33, P = 0.805) when compared with total IV anesthesia.
Conclusions：
The authors found no association between type of anesthesia used and the long-term prognosis of breast cancer. The results of this retrospective cohort study do not suggest specific selection of IV or inhalation anesthesia for breast cancer surgery.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
编辑：王贵龙 审校：李华宇