麻醉药物对成人心脏手术患者术后感染影响的回顾性队列研究  

Association between anesthesia regimen and postoperative infection in patients undergoing cardiac surgery:A retrospective cohort study

作　　者：田伟[1,2] 陈颖 玉红[1] 金亮[1,4] 余海[1] TIAN Wei;CHEN Ying;YU Hong;JIN Liang;YU Hai(Department of Anesthesiology,West China Hospital,Sichuan University,Chengdu,610041,P.R.China;Department of Anesthesiology,First People’s Hospital of Neijiang City,Neijiang,641000,Sichuan,P.R.China;Department of Anesthesiology,Liangshan Hospital of Integrated Traditional Chinese and Western Medicine,Liangshan,615000,Sichuan,P.R.China;Department of Anesthesiology,Leshan People’s Hospital,Leshan,614000,Sichuan,P.R.China)

机构地区：[1]四川大学华西医院麻醉科,成都610041 [2]内江市第一人民医院麻醉科,四川内江641000 [3]凉山州中西医结合医院麻醉科,四川凉山615000 [4]乐山市人民医院麻醉科,四川乐山614000

出　　处：《中国胸心血管外科临床杂志》2022年第5期585-591,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨麻醉药物(挥发性麻醉药或静脉麻醉药)与成人体外循环下心脏手术患者术后感染发生风险的关系。方法回顾性分析2019年6月—2020年6月四川大学华西医院496例择期行成人体外循环下心脏手术患者的临床资料,其中女251例、男245例,平均年龄(54.1±11.4)岁。美国麻醉医师协会分级Ⅰ~Ⅲ级。根据麻醉药物,将患者分为两组:以七氟烷或地氟烷为主的吸入麻醉组243例,以丙泊酚为主的静脉麻醉组253例。主要结局指标:术后30 d内感染发生率,包括肺部感染、手术部位感染、脓毒血症和泌尿系统感染。次要结局指标:术后机械通气时间、再次气管插管率、ICU停留时间、术后住院时间、住院总费用。结果共155例(31.3%)患者发生了术后30 d内感染,吸入麻醉组发生率32.9%,静脉麻醉组发生率29.6%,差异无统计学意义[RR=1.111,95%CI(0.855,1.442),P=0.431]。两组次要指标差异无统计学意义(P>0.05)。结论术中麻醉维持药物(挥发性麻醉药或静脉麻醉药)的选择,不影响成人体外循环下心脏手术患者术后感染的发生风险。Objective To evaluate the association between anesthesia regimen(volatile or intravenous anesthetics)and postoperative infection in adult cardiac patients undergoing cardiac surgery.Methods The clinical data of 496 elective adults undergoing cardiac surgery under cardiopulmonary bypass from June 2019 to June 2020 in West China Hospital of Sichuan University were retrospectively analyzed,including 251 females and 245 males with an average age of 54.1±11.4 years.American Society of Anesthesiologists grade wasⅠ-Ⅲ.There were 243 patients in a volatile group with sevoflurane or desflurane,and 253 patients in an intravenous anesthesia group with propofol.The primary outcome was the incidence of infection within 30 days after cardiac surgery,including pulmonary infection,surgical site infection,sepsis,and urinary tract infection.The secondary outcomes were duration of mechanical ventilation,incidence of reintubation,ICU stay,postoperative length of hospital stay and total hospitalization cost.Results A total of 155(31.3%)patients developed postoperative infection within 30 days,with an incidence of 32.9%in the volatile group and 29.6%in the intravenous anesthesia group.There was no statistical difference in the incidence of infection(RR=1.111,95%CI 0.855to 1.442,P=0.431)or the secondary outcomes(P>0.05)between the two groups.Conclusion The anesthesia regimen(volatile or intravenous anesthetics)has no association with the risk of occurrence of postoperative infection in adult patients undergoing elective cardiac surgery with cardiopulmonary bypass.

关 键 词：挥发性麻醉药 七氟烷 地氟烷 静脉麻醉药 丙泊酚 体外循环 心脏手术 术后感染 

分 类 号：R614[医药卫生—麻醉学]