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【lancet】颈动脉手术（GALA）的全身麻醉与局部麻
General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial
颈动脉手术（GALA）的全身麻醉与局部麻醉：多中心、随机对照研究
Background
The effect of carotid endarterectomy in lowering the risk of stroke ipsilateral to severe atherosclerotic carotid-artery stenosis is offset by complications during or soon after surgery. We compared surgery under general anaesthesia with that under local anaesthesia because prediction and avoidance of perioperative strokes might be easier under local anaesthesia than under general anaesthesia.
Methods
We undertook a parallel group, multicentre, randomised controlled trial of 3526 patients with symptomatic or asymptomatic carotid stenosis from 95 centres in 24 countries. Participants were randomly assigned to surgery under general (n=1753) or local (n=1773) anaesthesia between June, 1999 and October, 2007. The primary outcome was the proportion of patients with stroke (including retinal infarction), myocardial infarction, or death between randomisation and 30 days after surgery. Analysis was by intention to treat. The trial is registered with Current Control Trials number ISRCTN00525237.
Findings
A primary outcome occurred in 84 (4.8%) patients assigned to surgery under general anaesthesia and 80 (4.5%) of those assigned to surgery under local anaesthesia; three events per 1000 treated were prevented with local anaesthesia (95% CI −11 to 17; risk ratio [RR] 0.94 [95% CI 0.70 to 1.27]). The two groups did not significantly differ for quality of life, length of hospital stay, or the primary outcome in the prespecified subgroups of age, contralateral carotid occlusion, and baseline surgical risk.
Interpretation
We have not shown a definite difference in outcomes between general and local anaesthesia for carotid surgery. The anaesthetist and surgeon, in consultation with the patient, should decide which anaesthetic technique to use on an individual basis. 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial
颈动脉手术（GALA）的全身麻醉与局部麻醉：多中心、随机对照研究
Background
The effect of carotid endarterectomy in lowering the risk of stroke ipsilateral to severe atherosclerotic carotid-artery stenosis is offset by complications during or soon after surgery. We compared surgery under general anaesthesia with that under local anaesthesia because prediction and avoidance of perioperative strokes might be easier under local anaesthesia than under general anaesthesia.
背景 对于单侧严重的颈动脉粥样硬化性狭窄进行颈动脉内膜剥脱术来预防中风的效用正在被围手术期的并发症所抵消。我们将全麻手术与局麻手术做比较，因为理论上来说局麻下手术较之全麻下手术可以更好的预测和避免围手术期中风的发生。
Methods
We undertook a parallel group, multicentre, randomised controlled trial of 3526 patients with symptomatic or asymptomatic carotid stenosis from 95 centres in 24 countries. Participants were randomly assigned to surgery under general (n=1753) or local (n=1773) anaesthesia between June, 1999 and October, 2007. The primary outcome was the proportion of patients with stroke (including retinal infarction), myocardial infarction, or death between randomisation and 30 days after surgery. Analysis was by intention to treat. The trial is registered with Current Control Trials number ISRCTN00525237.
方法 我们启动了一项平行的、多中心的、随机对照试验，它纳入了24个国家95个中心的3526位有症状或无症状颈动脉狭窄病人。在1999年6月至2007年10月之间，受试者随机被分配到全麻组（1753）或局麻组（1773）。目标事件是自随机分组后至手术后30天病人发生中风（包括视网膜梗死）、心肌梗死、甚至死亡的比例。研究采用了ITT分析(意向性分析)，这项研究的登记文号是ISRCTN00525237。
Findings
A primary outcome occurred in 84 (4.8%) patients assigned to surgery under general anaesthesia and 80 (4.5%) of those assigned to surgery under local anaesthesia; three events per 1000 treated were prevented with local anaesthesia (95% CI −11 to 17; risk ratio [RR] 0.94 [95% CI 0.70 to 1.27]).[标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-02-15 17:11
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