Pasternak Jeffrey J, McGregor Diana G, Lanier William L, Schroeder Darrell R, Rusy Deborah A, Hindman Bradley, Clarke William, Torner James, Todd Michael M
Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Anesthesiology. 2009 Mar;110(3):563-73. doi: 10.1097/ALN.0b013e318197ff81.
The authors explored the relationship between nitrous oxide use and neurologic and neuropsychological outcome in a population of patients likely to experience intraoperative cerebral ischemia: those who had temporary cerebral arterial occlusion during aneurysm clipping surgery.
A post hoc analysis of a subset of the data from the Intraoperative Hypothermia for Aneurysm Surgery Trial was conducted. Only subjects who had temporary arterial occlusion during surgery were included in the analysis. Metrics of short-term and long-term (i.e., 3 months after surgery) outcome were evaluated via both univariate and multivariate logistic regression analysis. An odds ratio (OR) greater than 1.0 denotes a worse outcome in patients receiving nitrous oxide.
The authors evaluated 441 patients, of which 199 received nitrous oxide. Patients receiving nitrous oxide had a greater risk of delayed ischemic neurologic deficits (i.e., the clinical manifestation of vasospasm) (OR, 1.78, 95% confidence interval [CI], 1.08-2.95; P = 0.025). However, at 3 months after surgery, there was no difference in any metric of gross neurologic outcome: Glasgow Outcome Score (OR, 0.67; CI, 0.44-1.03; P = 0.065), Rankin Score (OR, 0.74; CI, 0.47-1.16; P = 0.192), National Institutes of Health Stroke Scale (OR, 1.02; CI, 0.66-1.56; P = 0.937), or Barthel Index (OR, 0.69; CI, 0.38-1.25; P = 0.22). The risk of impairment on at least one test of neuropsychological function was reduced in those who received nitrous oxide (OR, 0.56; CI, 0.36-0.89; P = 0.013).
In this patient population, use of nitrous oxide was associated with an increased risk for the development of delayed ischemic neurologic deficits; however, there was no evidence of detriment to long-term gross neurologic or neuropsychological outcome.
作者在可能经历术中脑缺血的患者群体中探究了氧化亚氮的使用与神经及神经心理学预后之间的关系，这些患者在动脉瘤夹闭手术期间有临时脑动脉闭塞情况。
对动脉瘤手术中低温治疗试验数据的一个子集进行事后分析。分析仅纳入手术期间有临时动脉闭塞的受试者。通过单变量和多变量逻辑回归分析评估短期和长期（即术后3个月）预后指标。比值比（OR）大于1.0表示接受氧化亚氮的患者预后较差。
作者评估了441例患者，其中199例接受了氧化亚氮。接受氧化亚氮的患者发生延迟性缺血性神经功能缺损（即血管痉挛的临床表现）的风险更高（OR，1.78；95%置信区间[CI]，1.08 - 2.95；P = 0.025）。然而，术后3个月时，在任何总体神经功能预后指标方面均无差异：格拉斯哥预后评分（OR，0.67；CI，0.44 - 1.03；P = 0.065）、Rankin评分（OR，0.74；CI，0.47 - 1.16；P = 0.192）、美国国立卫生研究院卒中量表（OR，1.02；CI，0.66 - 1.56；P = 0.937）或巴氏指数（OR，0.69；CI，0.38 - 1.25；P = 0.22）。接受氧化亚氮的患者在至少一项神经心理学功能测试中出现损伤的风险降低（OR，0.56；CI，0.36 - 0.89；P = 0.013）。
在该患者群体中，氧化亚氮的使用与延迟性缺血性神经功能缺损发生风险增加相关；然而，没有证据表明对长期总体神经或神经心理学预后有损害。
