20 / 10 / 16
关于“挥发性麻醉药与全静脉麻醉用于心脏手术的比较”一文医学翻译摘要学习情况，记录于此。
Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery
背景
BACKGROUND
挥发性（吸入）麻醉药具有心肌保护作用，可能改善接受冠状动脉旁路移植术（CABG）患者的临床结局。
Volatile (inhaled) anesthetic agents have cardioprotective effects, which might improve clinical outcomes in patients undergoing coronary-artery bypass grafting (CABG).
笔记：
方法
METHODS
我们在13个国家36个研究中心开展了一项实用性、多中心、单盲、对照试验。
We conducted a pragmatic, multicenter, single-blind, controlled trial at 36 centers in 13 countries.
笔记：
计划接受择期CABG的患者被随机分组，分别采用包括一种挥发性麻醉药（地氟醚、异氟醚或七氟醚）的术中麻醉方案或采用全静脉麻醉。
Patients scheduled to undergo elective CABG were randomly assigned to an intraoperative anesthetic regimen that included a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or to total intravenous anesthesia.
笔记：
主要结局是1年时的全因死亡。
The primary outcome was death from any cause at 1 year.
笔记：
结果
RESULTS
共有5,400例患者被随机分组：2,709例被分配至挥发性麻醉药组，2,691例被分配至全静脉麻醉组。
A total of 5400 patients were randomly assigned: 2709 to the volatile anesthetics group and 2691 to the total intravenous anesthesia group.
笔记：
64%的患者接受了停跳CABG，体外循环的平均持续时间为79分钟。
A On-pump CABG was performed in 64% of patients, with a mean duration of cardiopulmonary bypass of 79 minutes.
笔记：
两组的基线人口统计学和临床特征、体外循环持续时间和桥血管数量相似。
The two groups were similar with respect to demographic and clinical characteristics at baseline, the duration of cardiopulmonary bypass, and the number of grafts.
第二次期中分析时，由于无效（futility），数据和安全监察委员会建议终止试验。
At the time of the second interim analysis, the data and safety monitoring board advised that the trial should be stopped for futility.
两组1年（有5,353例患者[99.1%]的数据可用；挥发性麻醉药组的全因死亡率2.8%，全静脉麻醉组3.0%；相对危险度，0.94；95%置信区间[CI]，0.69～1.29；P=0.71）和30日（有5,398例患者[99.9%]的数据可用；全因死亡率分别为1.4%和1.3%；相对危险度，1.11；95% CI，0.70～1.76）时的全因死亡率无显著差异。
No significant difference between the groups with respect to deaths from any cause was seen at 1 year (2.8% in the volatile anesthetics group and 3.0% in the total intravenous anesthesia group; relative risk, 0.94; 95% confidence interval [CI], 0.69 to 1.29; P=0.71), with data available for 5353 patients (99.1%), or at 30 days (1.4% and 1.3%, respectively; relative risk, 1.11; 95% CI, 0.70 to 1.76), with data available for 5398 patients (99.9%).
笔记：
两组的次要结局或预设不良事件（包括心肌梗死）发生率均无显著差异。
There were no significant differences between the groups in any of the secondary outcomes or in the incidence of prespecified adverse events, including myocardial infarction.
笔记：
结论
CONCLUSIONS
在接受择期CABG的患者中，与全静脉麻醉相比，采用挥发性麻醉药未显著减少1年时的患者死亡数量（由意大利卫生部[Italian Ministry of Health]资助；MYRIAD在ClinicalTrials.gov注册号为NCT02105610）。
Among patients undergoing elective CABG, anesthesia with a volatile agent did not result in significantly fewer deaths at 1 year than total intravenous anesthesia. (Funded by the Italian Ministry of Health; MYRIAD ClinicalTrials.gov number, NCT02105610 .)
CABG是全球范围内最常实施的大手术1,2 。
Coronary-artery bypass grafting (CABG) is the most common major surgical procedure performed worldwide.1,2
仅美国每年就实施超过300,000例CABG手术3 ，据报告1年死亡率为2%～3% 4,5 。
More than 300,000 CABG procedures are performed each year in the United States alone,3 with the incidence of death at 1 year reported to be 2 to 3%.4,5
CABG期间的麻醉一般单纯使用静脉麻醉药（全静脉麻醉）诱导或联合使用挥发性（吸入）麻醉药和静脉麻醉药诱导。
Anesthesia during CABG is typically induced with intravenous drugs only (total intravenous anesthesia) or with a combination of volatile (inhaled) and intravenous agents.
在器官缺血之前、期间或之后给予挥发性麻醉药时，药物可通过多种机制发挥细胞保护作用。
When volatile anesthetics are administered before, during, or after periods of organ ischemia, they exert cellprotective effects through multiple mechanisms.
笔记：
这些机制包括调节G蛋白偶联受体、细胞内信号通路、基因表达、钾通道和线粒体功能6 。
These mechanisms include modulation of G-protein–coupled receptors, intracellular signaling pathways, gene expression, potassium channels, and mitochondrial function.6
笔记：
此外，在动物模型中，挥发性麻醉药可减小心肌梗死面积7 。
Moreover, volatile anesthetics reduce myocardial infarct size in animal models.7
数项随机对照试验表明，挥发性麻醉药可降低心肌损伤的生物标志物7,8 ，即使麻醉药仅在缺血前短暂使用9 。
Several randomized, controlled trials have shown that volatile anesthetics reduce biomarkers of myocardial injury,7,8 even if the anesthetics are administered for only a short duration before ischemia.9
荟萃分析表明，使用挥发性麻醉药的CABG术后死亡率下降10-12 ，这一发现与中等规模随机对照试验的观察结果一致13-15 。
Meta-analyses have shown a reduction in mortality after CABG with volatile anesthetics,10-12 a finding that is consistent with observations from moderate-sized randomized, controlled trials.13-15
笔记：
两项国际共识会议确定，使用挥发性麻醉药是提高大手术患者生存率的关键非手术干预措施16,17 ，这对于每年超过3亿例患者有潜在临床意义18 。
Two international consensus conferences identified the use of volatile anesthetics as a key nonsurgical intervention to improve survival among patients undergoing major surgery,16,17 with potential clinical implications for more than 300 million patients each year.18
笔记：
最后，美国心脏病学会（American College of Cardiology）和美国心脏学会（American Heart Association）指南以及欧洲心胸外科学会（European Association for Cardiothoracic Surgery）指南建议将这些发现用于心脏手术患者的麻醉管理19,20 。
Finally, the guidelines from the American College of Cardiology and American Heart Association and the guidelines from the European Association for Cardiothoracic Surgery have suggested that these findings should be applied to the management of anesthesia in patients undergoing cardiac surgery.19,20
然而，其他随机、对照试验和荟萃分析未证实挥发性麻醉药有益8,21,22 ，因此提示这一问题尚未最终解决。
However, other randomized, controlled trials and meta-analyses did not confirm a benefit of volatile anesthetics,8,21,22 which suggests that this issue is not definitively resolved.
我们设计并开展了一项大规模、多中心、多国、随机、对照试验，以检验以下假设，与全静脉麻醉相比，CABG术中使用挥发性麻醉药将减少患者死亡数量。
We designed and conducted a large, multicenter, multinational, randomized, controlled trial to test the hypothesis that the use of volatile anesthetics during CABG would result in a lower number of deaths than total intravenous anesthesia.