一氧化二氮对颅内动脉瘤手术后神经和神经心理功能的影响。

Effect of nitrous oxide on neurologic and neuropsychological function after intracranial aneurysm surgery.

作者信息

McGregor Diana G, Lanier William L, Pasternak Jeffrey J, Rusy Deborah A, Hogan Kirk, Samra Satwant, Hindman Bradley, Todd Michael M, Schroeder Darrell R, Bayman Emine Ozgur, Clarke William, Torner James, Weeks Julie

机构信息

Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.

出版信息

Anesthesiology. 2008 Apr;108(4):568-79. doi: 10.1097/ALN.0b013e31816721fa.

DOI:10.1097/ALN.0b013e31816721fa

PMID:18362587

Abstract

BACKGROUND

Laboratory studies suggest that nitrous oxide augments brain injury after ischemia or hypoxia. The authors examined the relation between nitrous oxide use and outcomes using data from the Intraoperative Hypothermia for Aneurysm Surgery Trial.

METHODS

The Intraoperative Hypothermia for Aneurysm Surgery Trial was a prospective randomized study of the impact of intraoperative hypothermia (temperature = 33 degrees C) versus normothermia (temperature = 36.5 degrees C) in patients with aneurysmal subarachnoid hemorrhage undergoing surgical clipping. Anesthesia was dictated by a limited-options protocol with the use of nitrous oxide determined by individual anesthesiologists. All patients were assessed daily for 14 days after surgery or until hospital discharge. Neurologic and neuropsychological testing were conducted at 3 months after surgery. Outcome data were analyzed via both univariate tests and multivariate logistic regression analysis correcting for factors thought to influence outcome. An odds ratio (OR) greater than 1.0 denotes a worse outcome in patients receiving nitrous oxide.

RESULTS

Outcome data were available for 1,000 patients, of which 373 received nitrous oxide. There was no difference between groups in the development of delayed ischemic neurologic deficit. At 3 months after surgery, there were no significant differences between groups in any outcome variable: Glasgow Outcome Score (OR, 0.84; 95% confidence interval [CI], 0.63-1.14; P = 0.268), National Institutes of Health Stroke Scale (OR, 1.29; 95% CI, 0.96-1.73; P = 0.087), Rankin Disability Score (OR, 0.84; 95% CI, 0.61-1.15; P = 0.284), Barthel Activities of Daily Living Index (OR, 1.01; 95% CI, 0.68-1.51; P = 0.961), or neuropsychological testing (OR, 1.26; 95% CI, 0.85-1.87; P = 0.252).

CONCLUSIONS

In a population of patients at risk for ischemic brain injury, nitrous oxide use had no overall beneficial or detrimental impact on neurologic or neuropsychological outcomes.

摘要

背景

实验室研究表明，氧化亚氮会加重缺血或缺氧后的脑损伤。作者利用动脉瘤手术术中低温试验的数据，研究了氧化亚氮的使用与预后之间的关系。

方法

动脉瘤手术术中低温试验是一项前瞻性随机研究，旨在探讨术中低温（体温 = 33摄氏度）与正常体温（体温 = 36.5摄氏度）对接受手术夹闭的动脉瘤性蛛网膜下腔出血患者的影响。麻醉采用有限选择方案，由个体麻醉医生决定是否使用氧化亚氮。所有患者在术后14天内每天进行评估，直至出院。术后3个月进行神经学和神经心理学测试。通过单变量测试和多变量逻辑回归分析对结果数据进行分析，并对认为会影响预后的因素进行校正。比值比（OR）大于1.0表示接受氧化亚氮的患者预后较差。

结果

1000例患者有预后数据，其中373例使用了氧化亚氮。两组在迟发性缺血性神经功能缺损的发生方面无差异。术后3个月，两组在任何预后变量上均无显著差异：格拉斯哥预后评分（OR，0.84；95%置信区间[CI]，0.63 - 1.14；P = 0.268）、美国国立卫生研究院卒中量表（OR，1.29；95% CI，0.96 - 1.73；P = 0.087）、Rankin残疾评分（OR，0.84；95% CI，0.61 - 1.15；P = 0.284）、Barthel日常生活活动指数（OR，1.01；95% CI，0.68 - 1.51；P = 0.961）或神经心理学测试（OR，1.26；95% CI，0.85 - 1.87；P = 0.252）。