麻醉对肺手术患者术后早期认知结局及术中脑氧平衡的影响：一项随机临床试验
Effects of anesthetics on early postoperative cognitive outcome and intraoperative cerebral oxygen balance in patients undergoing lung surgery: a randomized clinical trial.
作者信息
Egawa Junji, Inoue Satoki, Nishiwada Tadashi, Tojo Takashi, Kimura Michitaka, Kawaguchi Takeshi, Taniguchi Shigeki, Furuya Hitoshi, Kawaguchi Masahiko
机构信息
Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Kashihara, Japan.
出版信息
Can J Anaesth. 2016 Oct;63(10):1161-1169. doi: 10.1007/s12630-016-0700-4. Epub 2016 Jul 13.
PURPOSE
One-lung ventilation (OLV) may impair cerebral oxygen balance and induce postoperative cognitive dysfunction (POCD). It is unclear whether the type of anesthetic influences the incidence of POCD in patients undergoing OLV. This prospective study compared the incidence of POCD and intraoperative cerebral oxygen desaturation in OLV patients anesthetized with propofol vs sevoflurane during lung surgery.
METHODS
There were 148 participants enrolled in this study and randomized equally to either the propofol or the sevoflurane group. Anesthesia was maintained with either propofol or sevoflurane combined in both groups with fentanyl and epidural anesthesia. Regional cerebral oxygen saturation (rSO2), jugular bulb venous oxygen saturation (SjO2), and the incidence of cerebral oxygen desaturation (rSO2 or SjO2 < 50% or rSO2 < 80% of baseline) were measured during anesthesia. Cognitive function was assessed using seven neurocognitive tests two days preoperatively, five days postoperatively (primary outcome), and three months postoperatively. Bivariable and multivariable regression analyses were conducted to identify factors associated with POCD.
RESULTS
Rates of POCD did not differ statistically between groups five days postoperatively (propofol, 16/72 patients; sevoflurane, 24/72 patients; RR, 0.67; 95% CI, 0.39 to 1.15; P = 0.14) or three months postoperatively (propofol, 9/60 patients; sevoflurane, 12/58 patients; RR, 0.73; 95% CI, 0.33 to 1.59; P = 0.42). Only three subjects per group showed intraoperative cerebral oxygen desaturation. Multivariable regression analysis revealed older age as an independent predictor of POCD.
CONCLUSIONS
No statistically significant difference in the incidence of POCD could be detected between the sevoflurane and propofol anesthesia groups. Postoperative cognitive dysfunction was relatively frequent following OLV in both groups. (
REGISTRATION NUMBER
UMIN 000002826).
目的
单肺通气（OLV）可能会损害脑氧平衡并诱发术后认知功能障碍（POCD）。目前尚不清楚麻醉类型是否会影响接受OLV患者的POCD发生率。这项前瞻性研究比较了在肺部手术中接受丙泊酚或七氟醚麻醉的OLV患者的POCD发生率和术中脑氧饱和度降低情况。
方法
本研究共纳入148名参与者，将其平均随机分为丙泊酚组或七氟醚组。两组均采用丙泊酚或七氟醚联合芬太尼及硬膜外麻醉维持麻醉。在麻醉期间测量局部脑氧饱和度（rSO2）、颈静脉球部血氧饱和度（SjO2）以及脑氧饱和度降低（rSO2或SjO2 < 50%或rSO2 < 基线的80%）的发生率。在术前2天、术后5天（主要结局）和术后3个月使用七项神经认知测试评估认知功能。进行双变量和多变量回归分析以确定与POCD相关的因素。
结果
术后5天（丙泊酚组，16/72例患者；七氟醚组，24/72例患者；RR，0.67；95%CI，0.39至1.15；P = 0.14）或术后3个月（丙泊酚组，9/60例患者；七氟醚组，12/58例患者；RR，0.73；95%CI，0.33至1.59；P = 0.42），两组间POCD发生率无统计学差异。每组仅3名受试者出现术中脑氧饱和度降低。多变量回归分析显示年龄较大是POCD的独立预测因素。
结论
七氟醚和丙泊酚麻醉组之间未检测到POCD发生率的统计学显著差异。两组在OLV后术后认知功能障碍相对常见。（注册号：UMIN 000002826）
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