氙气与七氟醚麻醉用于冠状动脉手术患者的可行性和安全性：一项随机对照的初步研究。

Feasibility and safety of xenon compared with sevoflurane anaesthesia in coronary surgical patients: a randomized controlled pilot study.

机构信息

Department of Anesthesiology, RWTH University Hospital, Pauwelsstr. 30, D-52074 Aachen, Germany.

出版信息

Br J Anaesth. 2013 Sep;111(3):406-16. doi: 10.1093/bja/aet072. Epub 2013 Apr 11.

DOI:10.1093/bja/aet072

PMID:23578862

Abstract

BACKGROUND

To date, only limited data exist about the use of xenon as an anaesthetic agent in patients undergoing cardiac surgery. The favourable cardio- and neuroprotective properties of xenon might attenuate postoperative complications, improve outcome, and reduce the incidence of delirium. Thus, the aims of this study were to investigate the feasibility and safety of balanced xenon anaesthesia in patients undergoing cardiac surgery and to gather pilot data for a future randomized multicentre study.

METHODS

Thirty patients undergoing elective coronary artery bypass grafting were enrolled in this randomized, single-blind controlled trial. They were randomized to receive balanced general anaesthesia with either xenon (45-50 vol%) or sevoflurane (1-1.4 vol%). The primary outcome was the occurrence of adverse events (AEs). Secondary outcome parameters were feasibility criteria (bispectral index, perioperative haemodynamic, and respiratory profile) and safety parameters (dosage of study treatments, renal function, intraoperative blood loss, need for inotropic support, regional cerebral tissue oxygenation). Furthermore, at predefined time points, systemic and pulmonary haemodynamics were assessed by the use of a pulmonary artery catheter.

RESULTS

There were no patient characteristic differences between the groups. Patients undergoing xenon anaesthesia did not differ with respect to the incidence of AE (6 vs 8, P=0.464) compared with the sevoflurane group. No differences were detected regarding secondary feasibility and safety criteria. The haemodynamic and respiratory profile was comparable between the treatment groups.

CONCLUSIONS

Balanced xenon anaesthesia is feasible and safe compared with sevoflurane anaesthesia in patients undergoing coronary artery bypass surgery. Acronym CARDIAX: A pre- and post-coronary artery bypass graft implantation disposed application of xenon. Clinical trial registration ClinicalTrials.gov: NCT01285271; EudraCT-number: 2010-023942-63. Approved by the ethics committee 'Ethik-Kommission an der Medizinischen Fakultät der Rheinisch-Westfälischen Technischen Hochschule Aachen (RWTH Aachen)': EK-218/10.

摘要

背景

迄今为止，关于氙气作为心脏手术患者麻醉剂的使用，仅有有限的数据。氙气具有良好的心脏和神经保护特性，可能减轻术后并发症，改善结果，并降低谵妄发生率。因此，本研究旨在探讨心脏手术患者中平衡氙气麻醉的可行性和安全性，并为未来的随机多中心研究收集初步数据。

方法

本研究纳入了 30 名接受择期冠状动脉旁路移植术的患者，他们被随机分为两组，接受平衡全身麻醉，分别使用氙气（45-50 体积%）或七氟醚（1-1.4 体积%）。主要结局是不良事件（AE）的发生。次要结局参数是可行性标准（脑电双频指数、围手术期血流动力学和呼吸特征）和安全性参数（研究治疗药物的剂量、肾功能、术中失血量、对正性肌力支持的需求、局部脑组织氧合）。此外，在预定的时间点，通过肺动脉导管评估全身和肺血流动力学。

结果

两组患者的一般特征无差异。与七氟醚组相比，接受氙气麻醉的患者在 AE 发生率方面没有差异（6 例与 8 例，P=0.464）。在次要可行性和安全性标准方面没有差异。两组的血流动力学和呼吸特征相似。

结论

与七氟醚麻醉相比，平衡氙气麻醉在接受冠状动脉旁路手术的患者中是可行且安全的。缩略语 CARDIAX：在冠状动脉旁路移植术前后应用氙气。临床试验注册 ClinicalTrials.gov：NCT01285271；EudraCT 编号：2010-023942-63。由莱茵威斯特伐利亚技术大学医学伦理委员会（RWTH Aachen 医学院伦理委员会）批准：EK-218/10。