全凭静脉与静吸复合麻醉对肝癌根治术后患者生存率影响总体无差异但特定亚组风险增高:一项回顾性队列研究OA
目的 探讨基于丙泊酚的全凭静脉麻醉(total intravenous anesthesia,TIVA)和基于七氟烷联合丙泊酚静吸复合麻醉(intravenous-inhalation combined anesthesia,IICA)对肝癌根治患者术后5年生存率的影响.方法 本研究采用回顾性队列研究设计方案,分析陆军军医大学第一附属医院麻醉科2015年1月至2017年12月期间行肝癌根治术患者504例的临床及随访资料,按照麻醉方式不同分为IICA组(n=176)和TIVA组(n=328).比较在2种不同麻醉方式下接受肝癌根治术,患者术后5年的生存率;并按年龄段、肿瘤大小及数量、终末期肝病模型(model for end-stage liver disease,MELD)评分、是否有门静脉癌栓(portal vein tumor thrombus,PVTT)、术中是否输血、乙肝表面抗原(hepatitis B surface antigen,HBsAg)、甲胎蛋白(alpha fetoprotein,AFP)浓度、肿瘤-淋巴-结转移(tumor node metastasis,TNM)分期、巴塞罗那临床肝癌(Barcelona clinic liver cancer,BCLC)分期等进行分层分析,比较亚组下接受2种麻醉方式对肝癌根治术患者术后生存率的影响.结果 在肝癌根治术患者中,TIVA组肝癌根治术患者5年生存时间为33.00(14.25,60.00)个月,死亡212例(64.60%).IICA组肝癌根治术患者5年生存时间为27.00(11.00,60.00)个月,死亡125例(71.00%).在IICA和TIVA下接受肝癌根治术的2组患者术后5年的生存率差异无统计学意义(HR=1.27,95%CI:0.96～1.67,P>0.05).分层分析发现,MELD评分>7.24(HR=1.61,95%CI:1.11～2.32,P=0.011)、BCLC分期B期(HR=1.74,95%CI:1.11～2.71,P=0.015)、无门静脉癌栓(R=1.35,95%CI:1.04～1.74,P=0.026)术中未接受输血(R=1.34,95%CI:1.02～1.75,P=0.034)的IICA组的患者5年死亡风险增高,亚组比较差异具有统计学意义.结论 在肝癌根治术患者中,TIVA组与IICA组的患者5年总体生存率无差异;但在术前MELD评分>7.24、无门静脉癌栓、BCLC分期B期、未输血的亚组中,IICA方案显著增加患者5年死亡风险.
Objective To investigate the impact of propofol-based total intravenous anesthesia(TIVA)versus sevoflurane-propofol intravenous-inhalation combined anesthesia(IICA)on 5-year postoperative survival rates in patients undergoing radical hepatectomy for hepatocellular carcinoma(HCC).Methods A retrospective cohort study was conducted on the clinical and follow-up data from 504 patients undergoing radical HCC surgery in our hospital between January 2015 and December 2017.According to different anesthesia techniques,the patients were divided into a IICA groups(n=176)and a TIVA group(n=328).The 5-year postoperative survival rates were compared between the 2 groups of patients.Stratified analyses were carried out by age,tumor size and number,Child-Pugh class and model for end-stage liver disease(MELD)score,presence of portal vein tumor thrombus(PVTT),intraoperative transfusion,hepatitis B surface antigen status,alpha-fetoprotein(AFP),tumor node metastasis(TNM)stage,and Barcelona clinic liver cancer(BCLC)stage to compare the impact of the 2 anesthesia methods on postoperative survival rates in subgroups.Results Among the cohort,the median 5-year survival was 33.00(14.25 to 60.00)months in the TIVA group with 212 deaths(64.60%),and 27.00(11.00 to 60.00)months in the IICA group with 125 deaths(71.00%).There was no statistically significant difference in 5-year survival rate between groups(HR=1.27,95%CI:0.96 to 1.67,P>0.05).Stratified analysis revealed significant increased 5-year mortality risk with CIVA in subgroups with MELD score>7.24(HR=1.61,95%CI:1.11 to 2.32,P=0.011),BCLC stage B(HR=1.74,95%CI:1.11 to 2.71,P=0.015),absence of PVTT(HR=1.35,95%CI:1.04 to 1.74,P=0.026),and no intraoperative transfusion(HR=1.34,95%CI:1.02 to 1.75,P=0.034).Conclusion Among patients undergoing radical hepatectomy for HCC,there is no difference in 5-year overall survival between propofol-based TIVA and sevoflurane-propofol IICA.However,IICA is associated with significantly increased 5-year mortality risk in specific subgroups:MELD score>7.24,absence of PVTT,BCLC stage B,and no intraoperative transfusion.
邱卓敏;李鑫雨;高宪;张宁;文静;王顺宏;李小东;陈志宇;甯交琳
陆军军医大学(第三军医大学)第一附属医院麻醉科,重庆陆军军医大学(第三军医大学)第一附属医院麻醉科,重庆陆军军医大学(第三军医大学)第一附属医院麻醉科,重庆陆军军医大学(第三军医大学)第一附属医院麻醉科,重庆陆军军医大学(第三军医大学)第一附属医院麻醉科,重庆陆军军医大学(第三军医大学)第一附属医院麻醉科,重庆陆军军医大学(第三军医大学)第一附属医院麻醉科,重庆陆军军医大学(第三军医大学)第一附属医院麻醉科,重庆陆军军医大学(第三军医大学)第一附属医院麻醉科,重庆
医药卫生
丙泊酚七氟烷全凭静脉麻醉肝癌生存率
propofolsevofluranetotal intravenous anesthesiahepatocellular carcinomasurvival rate
《陆军军医大学学报》 2026 (5)
583-591,9
国家自然科学基金面上项目(82270095) Supported by the General Program of National Natural Science Foundation of China(82270095).
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