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首页> 美国卫生研究院文献>Journal of Clinical Medicine >Anesthetic Agents and Cardiovascular Outcomes of Noncardiac Surgery after Coronary Stent Insertion
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Anesthetic Agents and Cardiovascular Outcomes of Noncardiac Surgery after Coronary Stent Insertion

机译：冠状动脉支架置入术后非心脏手术的麻醉药和心血管结果

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Patients undergoing noncardiac surgery after coronary stent implantation are at an increased risk of thrombotic complications. Volatile anesthetics are reported to have organ-protective effects against ischemic injury. Propofol has an anti-inflammatory action that can mitigate ischemia-reperfusion injury. However, the association between anesthetic agents and the risk of major adverse cardiovascular and cerebral event (MACCE) has never been studied before. In the present study, a total of 1630 cases were reviewed. Four different propensity score matchings were performed to minimize selection bias (propofol-based total intravenous anesthesia (TIVA) vs. volatile anesthetics; TIVA vs. sevoflurane; TIVA vs. desflurane; and sevoflurane vs. desflurane). The incidence of MACCE in these four propensity score-matched cohorts was compared. As a sensitivity analysis, a multivariable logistic regression analysis was performed to identify independent predictors for MACCE during the postoperative 30 days both in total and matched cohorts (TIVA vs. volatile agent). MACCE occurred in 6.0% of the patients. Before matching, there was a significant difference in the incidence of MACCE between TIVA and sevoflurane groups (TIVA 5.1% vs. sevoflurane 8.2%, = 0.006). After matching, there was no significant difference in the incidence of MACCE between the groups of any pairs (TIVA 6.5% vs. sevoflurane 7.7%; = 0.507). The multivariable logistic regression analysis revealed no significant association of the volatile agent with MACCE (odds ratio 1.48, 95% confidence interval 0.92–2.37, = 0.104). In conclusion, the choice of anesthetic agent for noncardiac surgery did not significantly affect the development of MACCE in patients with previous coronary stent implantation. However, further randomized trials are needed to confirm our results.
机译：冠状动脉支架植入后进行非心脏手术的患者发生血栓并发症的风险增加。据报道，挥发性麻醉药对缺血性损伤具有器官保护作用。丙泊酚具有抗炎作用，可以减轻缺血再灌注损伤。然而，麻醉剂与重大不良心血管和脑事件（MACCE）的风险之间的关联以前从未被研究过。在本研究中，共审查了1630例病例。进行了四个不同的倾向评分匹配，以最大程度地降低选择偏差（基于异丙酚的全静脉麻醉（TIVA）与挥发性麻醉剂； TIVA与七氟醚； TIVA与地氟醚；以及七氟醚与地氟醚）。比较了这四个倾向得分匹配的队列中MACCE的发生率。作为敏感性分析，进行了多变量logistic回归分析，以确定术后30天内总和匹配队列（TIVA与挥发性药物）的MACCE的独立预测因子。 MACCE发生在6.0％的患者中。匹配之前，TIVA和七氟醚组之间MACCE发生率存在显着差异（TIVA为5.1％，七氟醚为8.2％，= 0.006）。匹配后，任何一对组之间的MACCE发生率无显着差异（TIVA 6.5％对七氟醚7.7％； = 0.507）。多变量logistic回归分析显示，挥发性药物与MACCE没有显着相关性（几率1.48，95％置信区间0.92-2.37，= 0.104）。总之，非心脏手术麻醉剂的选择不会显着影响先前有冠状动脉支架置入术的患者MACCE的发展。但是，需要进一步的随机试验来确认我们的结果。

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