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摘要：

背景：手术前使用传统的中草药（TCHMs）的患者很广泛，但使用TCHMs对围术期的影响尚不清楚。作者对TCHM相关的围术期发生不良事件的发生率和危险性进行了研究。

方法：在香港的一个队列研究中，调查601名接受较大择期手术的患者在手术前的两周时间内西药和TCHM的使用情况。参与调查的麻醉科医生并不知道患者使用TCHMs的具体情况，他们对发生不能预测的围术期事件进行了记录。使用改良的Poisson回归方法对与使用TCHM相关的围术期不良事件进行相对危险度分析。

结果：601名患者中，手术前两周内，483名（80%）患者自己服用TCHM，47名（8%）处方服用TCHM（含或不含自己服用TCHM）。术前、术中和术后事件的总的发生率分别为23%（95%可信区间，19～26%）、74%（95%可信区间，71～78%）、63%（95%可信区间，59～66%）。与未使用TCHM者相比，通过处方服用TCHM的患者更易发生术前不良事件（校正相对危险度为2.21；95%可信区间，1.14～4.29%）。作者同时描述了4例处方服用TCHM的患者手术前出现活化部分凝血激酶时间（APTT）延长和低血钾。相比之下，TCHM的种类和术中、术后不良事件的发生率没有明显相关。

结论：在手术前的一段时间，应避免通过处方使用TCHM，因为可能增加术前不良事件的发生。

Incidence and Risk of Adverse Perioperative Events among Surgical Patients Taking Traditional Chinese Herbal Medicines

Anesthesiology. 105(3):454-461, September 2006.

Lee, Anna Ph.D., M.P.H. ; Chui, Po Tong F.A.N.Z.C.A. ; Aun, Cindy S. T. M.D. ; Lau, Angel S. C. B.S.N.(Hons) [S]; Gin, Tony M.D.

Abstract:

Background: The use of traditional Chinese herbal medicines (TCHMs) among the presurgical population is widespread, but their impact on perioperative patient care is unclear. The authors estimated the incidence and risk of TCHM-related perioperative events.

Methods: In a Hong Kong cohort study, 601 patients undergoing major elective surgery were asked about their Western medicine and TCHM use in the 2 weeks before surgery. Unanticipated perioperative events were noted by attending anesthesiologists, blinded to patients' use of specific TCHMs. Modified Poisson regression models were used to obtain the relative risk of combined endpoints of perioperative events associated with TCHM use.

Results: Of the 601 patients, 483 patients (80%) took self-prescribed TCHM, and 47 (8%) took TCHM by prescription (with or without self-prescribed TCHM) in the 2 weeks before surgery. The crude incidences of any combined endpoints of preoperative, intraoperative, and postoperative events were 23% (95% confidence interval, 19-26%), 74% (95% confidence interval, 71-78%), and 63% (95% confidence interval, 59-66%), respectively. Compared with nonusers, patients who took TCHM by prescription were more likely to have a preoperative event (adjusted relative risk, 2.21; 95% confidence interval, 1.14-4.29). The authors present four case reports to highlight the effect of TCHM by prescription on prolonged activated partial thromboplastin time and hypokalemia in the preoperative period. In contrast, there was no significant association between the use of any type of TCHM and the occurrence of either intraoperative or postoperative events.

Conclusions: The use of TCHM by prescription near the time of surgery should be discouraged because of the increased risk of adverse events in the preoperative period. 


编辑：西门吹血