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七氟醚和丙泊酚麻醉对颅脑外伤患者术后早期神经功能恢复的影响：一项回顾性队列研究
- Affiliations：
1. 1Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
2. 2Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- Author bio：
*weihuacui@ccmu.edu.cn
- Funds：
DOI：10.24920/004188
中图分类号：收稿日期：2022-11-03，
录用日期：2023-01-19，
网络出版日期：2023-02-06，
纸质出版日期：2023-06-30
- Accepted：
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吴蓓, 宋婉晴, 董金千, 等. 七氟醚和丙泊酚麻醉对颅脑外伤患者术后早期神经功能恢复的影响：一项回顾性队列研究[J]. 中国医学科学杂志（英文）, 2023,38(2):97-108.
Bei Wu, Wan-Qing Song, Jin-Qian Dong, et al. Effects of Sevoflurane and Propofol on Neurological Recovery of Traumatic Brain Injury Patients in the Early Postoperative Stage: A Retrospective Cohort Study[J]. Chinese medical sciences journal, 2023, 38(2): 97-108.
吴蓓, 宋婉晴, 董金千, 等. 七氟醚和丙泊酚麻醉对颅脑外伤患者术后早期神经功能恢复的影响：一项回顾性队列研究[J]. 中国医学科学杂志（英文）, 2023,38(2):97-108. DOI： 10.24920/004188.
Bei Wu, Wan-Qing Song, Jin-Qian Dong, et al. Effects of Sevoflurane and Propofol on Neurological Recovery of Traumatic Brain Injury Patients in the Early Postoperative Stage: A Retrospective Cohort Study[J]. Chinese medical sciences journal, 2023, 38(2): 97-108. DOI： 10.24920/004188.
摘要
目的
本研究旨在探讨丙泊酚和七氟醚对创伤性颅脑外伤（traumatic brain injury，TBI）患者术后早期神经功能恢复的影响。
方法
我们回顾性分析了244例行去骨瓣或非去骨瓣减压手术的TBI患者的临床资料。应用广义相加混合模型比较丙泊酚和七氟醚对患者术后第1、3、7天格拉斯哥昏迷（Glasgow Coma Scale，GCS）评分影响的差异。采用多元回归分析比较两种麻醉药对患者出院时格拉斯哥结局量表（GOS）评分影响的差异。
结果
丙泊酚组与七氟醚组患者入院时GCS评分的差异无统计学意义（
β
= 0.75，95%
CI
：-0.55~2.05，
P
= 0.260）。在接受非去骨瓣减压手术的患者中，七氟醚组术后GCS评分较基线水平升高的值显著低于丙泊酚组：在术后第1天低1.73（95%CI：-2.81~-0.66，
P
= 0.002），在术后第3天低2.03（95%CI：-3.14~-0.91，
P
<
0.001），在术后第7天低1.31（95%CI：-2.43~-0.19，
P
= 0.022）；在出院时，七氟醚组患者发生不良GOS评分（评分为1、2、3分）的风险较高（
OR
= 4.93，95%
CI
：1.05~23.03，
P
= 0.043）。在接受去骨瓣减压手术的患者中，两组GCS与GOS评分的差异无统计学意义。
结论
在接受非去骨瓣减压手术的TBI患者中，与丙泊酚相比，七氟醚可能与患者住院期间神经功能恢复较差相关；而在接受去骨瓣减压手术的TBI患者中，两者对患者神经功能恢复影响的差异不明显。
Abstract
Objective
To investigate the effects of propof
ol and sevoflurane on neurological recovery of traumatic brain injury (TBI) patients in the early postoperative stage.
Methods
We retrospectively analyzed the clinical data of TBI patients who underwent craniotomy or decompressive craniectomy. Generalized additive mixed model (GAMM) was used to analyze effects of propofol and sevoflurane on Glasgow Coma Scale (GCS) on postoperative days 1
3
and 7. Multivariate regression analysis was used to analyze effects of the two anesthetics on Glasgow Outcome Scale (GOS) at discharge.
Results
A total of 340 TBI patients were enrolled in this study. There were 110 TBI patients who underwent craniotomy including 75 in the propofol group and 35 in the sevoflurane group
and 134 patients who underwent decompressive craniectomy including 63 in the propofol group and 71 in the sevoflurane group. It showed no significant difference in GCS at admission between the propofol and the sevoflurane groups among craniotomy patients (
β
= 0.75
95%
CI
: -0.55 to 2.05
P
= 0.260). However
elevation in GCS from baseline was 1.73 points (95%
CI
: -2.81 to -0.66
P
= 0.002) less in the sevoflurane group than that in the propofol group on postoperative day 1
2.03 points (95%
CI
: -3.14 to -0.91
P
<
0.001) less on day 3
and 1.31 points (95%
CI
: -2.43 to -0.19
P
= 0.022) less on day 7. The risk of unfavorable GOS (GOS 1
2
and 3) at discharge was higher in the sevoflurane group (
OR
= 4.93
95%
CI
: 1.05 to 23.03
P
= 0.043). No significant difference was observed among two-group decompressive craniectomy patients in GCS and GOS.
Conclusions
Compared to propofol
sevoflurane was associated with worse neurological recovery during the hospital stay in TBI patients undergoing craniotomy. This difference was
not detected in TBI patients undergoing decompressive craniectomy.
关键词
Keywords
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