摘要
目的探讨不同麻醉方式对于肝细胞癌（HCC）术后预后的影响。方法选取中国医学科学院肿瘤医院2006年1月至2008年1月行手术治疗并获完整随访的HCC患者共185例。美国麻醉医师协会分级（ASA）Ⅰ～Ⅲ级，体质指数（BMI）为（22.8±4.6） kg/m2。其中，男169例，平均年龄56岁；女16例，平均年龄53岁。根据麻醉方式不同，将185例患者分为全凭静脉麻醉组53例，吸入麻醉组132例。近期随访对比术后疼痛及麻醉不良反应发生率，疼痛评分采用数字分级法（NRS），远期随访对比两组患者预后情况。结果全凭静脉麻醉组术后2 h NRS为2.0（0～2.0）分，疼痛程度明显低于吸入麻醉组的3.0（1.0～3.0）分，差异有统计学意义（Z＝－3.261，P＝0.001），而两组术后24 h的NRS分别为3.0（2.0～5.0）分和3.0（3.0～4.0）分，疼痛程度差异无统计学意义（Z＝－0.035，P＝0.972）。两组在术后镇静、恶心呕吐、躁动等不良反应发生率方面差异亦无统计学意义（均P〉0.05）。Kaplan－Meier单因素分析显示，两种麻醉方式对于无复发生存率及总生存率差异均无统计学意义（均P〉0.05）。Cox多因素分析亦显示两种麻醉方式不是影响HCC预后的独立影响因素。结论不同麻醉方式对于HCC长期预后无影响。
ObjectiveTo investigate the influence of different anesthetic techniques on the prognosis of hepatocellular carcinoma （HCC）after hepatectomy.MethodsA total of 185 consecutive patients with HCC confirmed underwent surgery in Cancer Hospital, Chinese Academy of Medical Sciences were recruited from January 2006 to January 2008. The patients were assessed as American Society of Anesthesiologists （ASA）Ⅰ-Ⅲ, with body mass index （BMI） （22.8±4.6）kg/m2. There were 169 males, with an average age of 56 years old and 16 females, with an average age of 53 years old. According to the different anesthesia methods, 185 patients were divided into two groups： total intravenous anesthesia group （TIVA） （n=53） and intravenous-inhalation combined anesthesia group （n=132）. Postoperative pain and adverse reactions were compared in recent follow-up, prognosis were compared in long-term follow-up.ResultsRecent follow-up showed that the NRS scores 2 hours after operation in TIVA group was 2.0 （0-2.0）, whereas those in intravenous-inhalation combined anesthesia group was 3.0 （1.0-3.0）. The pain in TIVA groups was significantly lower than that in intravenous-inhalation combined anesthesia group （Z=-3.261, P=0.001）. But for 24 hours after operation, the NRS scores in these two groups were 3.0 （2.0-5.0） and 3.0 （3.0-4.0）, respectively. There was no significant difference in the two groups （Z=-0.035, P=0.972）. In addition, there was no significant difference between the two groups in the incidence of sedation, nausea/vomiting, restlessness and other adverse reactions （all P〉0.05）. Long-term follow-up indicated that anesthetic techniques have no correlation with HCC prognosis in Kaplan-Meier analysis and Cox′s regression analysis.ConclusionThere is no significant effect of two anesthesia methods on the long-term prognosis of HCC.
作者
阎涛
赵建军
毕新宇
蔡建强
郑晖
Yan Tao Zhao Jianjun Bi Xinyu Cai Jianqiang Zheng Hui(Department of Anesthesiology, National Cancer Center/Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2017年第22期1719-1723,共5页
National Medical Journal of China
关键词
癌
肝细胞
麻醉
静脉
麻醉
吸入
Carcinoma, hepatocellular,Anesthesia, intravenous,Anesthesia, inhalation
