七氟醚与丙泊酚维持麻醉对行门诊妇科手术患者术后恢复质量的影响：一项前瞻性、随机、双盲、对照、临床试验。
The effect of sevoflurane compared to propofol maintenance on post-surgical quality of recovery in patients undergoing an ambulatory gynecological surgery: A prospective, randomized, double-blinded, controlled, clinical trial.
机构信息
Department of Anesthesiology, Rhode Island Hospital, Brown University, Providence, RI, USA; Department of Surgery, Alpert School of Medicine, Brown University, United States; Department of Health Services Research, Practice and Policy, The School of Public health, Brown University, United States.
Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
出版信息
J Clin Anesth. 2017 Dec;43:70-74. doi: 10.1016/j.jclinane.2017.10.001. Epub 2017 Oct 13.
OBJECTIVE
The main objective of the current investigation was to evaluate the effect of propofol used as anesthetic maintenance compared to sevoflurane on global post-surgical quality of recovery in female patients undergoing ambulatory gynecological surgery.
DESIGN
The study was a prospective randomized double blinded, controlled, clinical trial.
INTERVENTIONS
Healthy female subjects were randomized to receive propofol or sevoflurane as anesthetic maintenance.
MEASUREMENTS
The primary outcome was the Quality of Recovery 40 (QOR-40) questionnaire at 24h after surgery. Other data collected included opioid consumption, pain scores and time to hospital discharge. P<0.05 was used to reject the null hypothesis for the primary outcome.
MAIN RESULTS
Ninety subjects were randomized and sixty seven completed the study. Patient's baseline characteristics and surgical factors were not different between study groups. There was not a clinically significant difference in the global QoR-40 scores between the sevoflurane and the propofol groups, median (IQR) of 175 (163 to 181) and 176 (163 to 184), respectively, P=0.97. There was an inverse relationship (ρ=-0.42) between the opioid consumption in PACU (IV morphine equivalents) and 24h postoperative quality of recovery (P<0.001) and an inverse relationship (ρ=-0.48) between the oral opioid consumption at home (oral morphine equivalents) and 24h postoperative quality of recovery, P<0.001.
CONCLUSIONS
Our current results do not support the use of total intravenous anesthesia as an efficacious strategy to improve global quality of recovery after ambulatory surgery. Opioid consumption in the PACU is an earlier surrogate that can be utilized to identify ambulatory patients with a high likelihood to develop poor global quality of recovery and who may benefit from more efficacious strategies to improve global quality of recovery.
TRIAL REGISTRATION
ClinicalTrial.gov; url: http://www.clinicaltrials.gov; registration identified: NCT 01755234.
目的
本研究的主要目的是评估与七氟醚相比，丙泊酚作为维持麻醉对行日间妇科手术的女性患者术后整体康复质量的影响。
设计
这是一项前瞻性随机双盲、对照、临床试验。
干预措施
健康的女性患者被随机分为接受丙泊酚或七氟醚维持麻醉。
测量
主要结局是术后 24 小时时的恢复质量 40 （QOR-40）问卷。收集的其他数据包括阿片类药物的消耗、疼痛评分和出院时间。对于主要结局，P<0.05 用于拒绝零假设。
主要结果
90 名患者被随机分组，67 名患者完成了研究。研究组之间患者的基线特征和手术因素无差异。七氟醚组和丙泊酚组的整体 QoR-40 评分无显著差异，中位数（IQR）分别为 175（163 至 181）和 176（163 至 184），P=0.97。PACU（静脉注射吗啡等效物）的阿片类药物消耗与术后 24 小时的康复质量呈负相关（ρ=-0.42）（P<0.001），在家中口服阿片类药物（口服吗啡等效物）消耗与术后 24 小时的康复质量呈负相关（ρ=-0.48），P<0.001。
结论
我们目前的结果不支持使用全静脉麻醉作为一种有效的策略来改善日间手术后的整体康复质量。PACU 中的阿片类药物消耗是一种较早的替代指标，可以用来识别出在术后有较高可能出现整体康复质量差的日间患者，他们可能受益于更有效的策略来改善整体康复质量。
试验注册
ClinicalTrials.gov；网址：http://www.clinicaltrials.gov；注册识别码：NCT 01755234。
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