Department of Anesthesia, University of Iowa, Iowa City, Iowa, USA.
Anesthesiology. 2010 Jan;112(1):86-101. doi: 10.1097/ALN.0b013e3181c5e28f.
Although hypothermia and barbiturates improve neurologic outcomes in animal temporary focal ischemia models, the clinical efficacy of these interventions during temporary occlusion of the cerebral vasculature during intracranial aneurysm surgery (temporary clipping) is not established.
A post hoc analysis of patients from the Intraoperative Hypothermia for Aneurysm Surgery Trial who underwent temporary clipping was performed. Univariate and multivariate logistic regression methods were used to test for associations between hypothermia, supplemental protective drug, and short- (24-h) and long-term (3-month) neurologic outcomes. An odds ratio more than 1 denotes better outcome.
Patients undergoing temporary clipping (n = 441) were assigned to intraoperative hypothermia (33.3 degrees +/- 0.8 degrees C, n = 208) or normothermia (36.7 degrees +/- 0.5 degrees C, n = 233), with 178 patients also receiving supplemental protective drug (thiopental or etomidate) during temporary clipping. Three months after surgery, 278 patients (63%) had good outcome (Glasgow Outcome Score = 1). Neither hypothermia (P = 0.847; odds ratio = 1.043, 95% CI = 0.678-1.606) nor supplemental protective drug (P = 0.835; odds ratio = 1.048, 95% CI = 0.674-1.631) were associated with 3-month Glasgow Outcome Score. The effect of supplemental protective drug did not significantly vary with temperature. The effects of hypothermia and protective drug did not significantly vary with temporary clip duration. Similar findings were made for 24-h neurologic status and 3-month Neuropsychological Composite Score.
In the Intraoperative Hypothermia for Aneurysm Surgery Trial, neither systemic hypothermia nor supplemental protective drug affected short- or long-term neurologic outcomes of patients undergoing temporary clipping.
尽管低温和巴比妥类药物可改善动物短暂性局灶性缺血模型的神经功能预后，但在颅内动脉瘤手术期间（临时夹闭）暂时阻断脑血管期间，这些干预措施的临床疗效尚未确定。
对接受临时夹闭的颅内血管内手术试验中的患者进行了事后分析。使用单变量和多变量逻辑回归方法来测试低温、补充保护药物与短期（24 小时）和长期（3 个月）神经功能结局之间的关联。比值比大于 1表示预后更好。
接受临时夹闭的患者（n=441）被分配到术中低温（33.3°C ± 0.8°C，n=208）或常温（36.7°C ± 0.5°C，n=233），其中 178 例患者在临时夹闭期间还接受了补充保护药物（硫喷妥钠或依托咪酯）。手术后 3 个月，278 例患者（63%）预后良好（格拉斯哥结果评分=1）。低温（P=0.847；比值比=1.043，95%CI=0.678-1.606）和补充保护药物（P=0.835；比值比=1.048，95%CI=0.674-1.631）均与 3 个月时的格拉斯哥结果评分无关。补充保护药物的作用与温度无关。低温和保护药物的作用与临时夹闭持续时间无显著差异。24 小时神经状态和 3 个月神经心理学综合评分也有类似发现。
在颅内血管内手术试验中，全身低温或补充保护药物均未影响接受临时夹闭的患者的短期或长期神经功能结局。
