罂粟摘要 急诊腹部手术中应用硬膜外镇痛与术后死亡率的关系：一项基于人群的队列研究
急诊腹部手术中应用硬膜外镇痛与术后死亡率的关系：一项基于人群的队列研究
贵州医科大学 麻醉与心脏电生理课题组
翻译：马艳燕 编辑：马艳燕 审校：曹莹
急诊腹部手术发生死亡和术后并发症的风险相当大，包括肺部的并发症。在大多数择期手术中，硬膜外镇痛可降低术后死亡率和肺部并发症的发生。我们的目的是评估急诊腹部手术中硬膜外镇痛与死亡率的关系。
方法
在这项具有前瞻性数据收集、基于人群的队列研究中，我们纳入了2009年1月1日至2010年12月31日在13家丹麦医院行急诊开腹或腹腔镜手术的成年人。排除阑尾切除术。主要结局指标是术后90天的死亡率。次要结局指标是术后30天的死亡率和严重不良事件。我们使用二元Logistic回归分析(优势比(OR)，95%可信区间(CI))。
结果
我们共纳入4920例患者，其中1134例患者(23.0%)在术后90天内死亡。总体而言，27.9%的患者在围手术期接受硬膜外镇痛。在接受大型开腹手术的患者中，这一比例上升到34.0%。硬膜外镇痛与术后90天死亡率的粗略和校正关联分别为OR 0.99(95%CI：0.86~1.15，P=0.94)和OR 0.80(95%CI：0.67~0.94；P=0.01)。对于术后30天的死亡率，相应的估计值分别为OR 0.90(95%CI：0.76~1.06，P=0.21)和OR 0.75(95%CI：0.62~0.90，P<0.01)。没有严重不良事件的报道。
结论
在这项对于接受急诊腹部手术的成人患者进行的基于人群的队列研究中，我们发现，在调整后的分析中，围手术期硬膜外镇痛的应用与术后死亡率的降低有关。
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原始文献来源：Vester-Andersen M, Lundstrøm LH, Møller MH; Danish Anaesthesia Database. The association between epidural analgesia and mortality in emergency abdominal surgery: A population-based cohort study. Acta Anaesthesiol Scand. 2020 Jan;64(1):104-111.
The association between epidural analgesia and mortality in emergency abdominal surgery: A population-based cohort study
Abstract
Background:Emergency abdominal surgery carries a considerable risk of mortality and postoperative complications, including pulmonary complications. In major elective surgery, epidural analgesia reduces mortality and pulmonary complications. We aimed to evaluate the association between epidural analgesia and mortality in emergency abdominal surgery.
Methods: In this population-based cohort study with prospective data collection, we included adults undergoing emergency abdominal laparotomy or laparoscopy between 1 January 2009 and 31 December 2010 at 13 Danish hospitals. Appendectomies were excluded. The primary outcome was 90-day mortality. Secondary outcomes included 30-day mortality and serious adverse events. We used binary logistic regression analyses (odds ratios (ORs) with 95% confidence intervals (CIs)).
Results: We included 4 920 patients, of which 1 134 (23.0%) died within 90 days. Overall, 27.9% of the patients were treated with epidural analgesia perioperatively. This increased to 34.0% among patients undergoing major laparotomy. The crude and adjusted association between epidural analgesia and 90-day mortality was OR 0.99 (95%CI: 0.86-1.15, P=0.94) and OR 0.80 (95%CI: 0.67-0.94; P= 0.01), respectively. For 30-day mortality the corresponding estimates were OR 0.90 (95%CI: 0.76-1.06, P=0.21) and OR 0.75 (95%CI: 0.62-0.90, P<0.01), respectively. No serious adverse events were reported.
Conclusion: In this population-based cohort study of adult patients undergoing emergency abdominal surgery, we found that the use of epidural analgesia perioperatively was associated with a decreased risk of mortality in the adjusted analysis.