丙泊酚全凭静脉麻醉与地氟烷麻醉相比可提高胃癌手术患者生存率：回顾性分析
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丙泊酚全凭静脉麻醉与地氟烷麻醉相比可提高胃癌手术患者生存率：回顾性分析
翻译：唐剑 编辑：冯玉蓉 审校：曹莹
背景：癌症手术治疗可能会引起应激，增加癌症转移和复发的可能性。适当的手术和麻醉技术可能会影响患者的预后。虽然对此已经进行了许多相关研究，但关于麻醉技术对癌症患者预后的影响，很多研究结果相互矛盾。本研究旨在评估麻醉技术与胃癌手术患者的总体生存率和无癌复发生存率之间的关系。
方法：本研究回顾了2006年7月1日至2016年6月30日期间来我院就诊并被诊断为胃癌患者的电子病历。采用分类因素的对数秩检验对潜在的预后因素进行单因素分析，并将P值< 0.05的参数纳入多元回归分析。采用倾向性评分匹配来解释基线特征的差异：丙泊酚或地氟烷，比例为1：1。
结果：共有408名患者接受地氟烷(218例)和丙泊酚(190例)麻醉，符合分析条件。经倾向性评分匹配后，每组有167例患者。随访期间，地氟烷组总死亡率(56%)明显高于丙泊酚组(34%)(P<0 .001)。此外，地氟烷组患者(41%)出现术后转移的比例高于丙泊酚组(19%，P <0 .001)。
结论：麻醉类型与胃癌的远期预后有关。丙泊酚全凭静脉麻醉可改善胃癌患者手术后5年随访期的生存率，并降低了复发和转移的风险。
文献来源：Huang NC, Lee MS, Lai HC,et al. Propofol-based total intravenous anesthesia improves survival compared to desflurane anesthesia in gastric cancer surgery: A retrospective analysis.Medicine (Baltimore) 2020 Jun 19;9925(25)
Propofol-based total intravenous anesthesia improves survival compared to desflurane anesthesia in gastric cancer surgery: A retrospective analysis
Abstract
Surgical management of cancer may induce stress and increase the likelihood of cancer metastasis and recurrence. Appropriate surgical and anesthetic techniques may affect the patient's outcome. Although numerous studies have been performed, conflicting results have been obtained regarding the effect of anesthetic techniques on the outcome of patients with cancer. We conducted this study to evaluate the association of anesthetic techniques with overall and recurrence-free survival in patients who had undergone gastric cancer surgery.This retrospective study reviewed the electronic medical records of patients, who had visited our hospital and had been diagnosed with gastric cancer between July 1st, 2006 to June 30th, 2016. Univariate analysis of the potential prognostic factors was performed using the log-rank test for categorical factors, and parameters with a P-value < .05 at the univariate step were included in the multivariate regression analysis. Propensity Score Matching was performed to account for differences in baseline characteristics: propofol or desflurane, in a 1:1 ratio.A total of 408 patients anesthetized with desflurane (218) and propofol (190) were eligible for analysis. After propensity matching, 167 patients remained in each group. The overall mortality rate was significantly higher in the desflurane group (56%) than in the propofol group (34%) during follow-up (P < .001). In addition, a greater percentage of patients in the desflurane group (41%) exhibited postoperative metastasis than those in the propofol group (19%, P < .001).The authors found some association between types of anesthesia used and the long-term prognosis of gastric cancer. Propofol-based total intravenous anesthesia improved survival and reduced the risk of recurrence and metastasis during the 5-year follow-up period after gastric cancer surgery.
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