Wu Bei, Song Wan-Qing, Dong Jin-Qian, Yue Hong-Li, Lu Yu, Yu Yun, Hao Shu-Yu, Liu Bai-Yun, Cui Wei-Hua
Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
Chin Med Sci J. 2023 Jun 30;38(2):97-108. doi: 10.24920/004188.
Objective To investigate the effects of propofol and sevoflurane on neurological recovery of traumatic brain injury (TBI) patients in the early postoperative stage.Methods We retrospectively analyzed the clinical data of TBI patients who underwent craniotomy or decompressive craniectomy. Generalized additive mixed model (GAMM) was used to analyze effects of propofol and sevoflurane on Glasgow Coma Scale (GCS) on postoperative days 1, 3, and 7. Multivariate regression analysis was used to analyze effects of the two anesthetics on Glasgow Outcome Scale (GOS) at discharge.Results A total of 340 TBI patients were enrolled in this study. There were 110 TBI patients who underwent craniotomy including 75 in the propofol group and 35 in the sevoflurane group, and 134 patients who underwent decompressive craniectomy including 63 in the propofol group and 71 in the sevoflurane group. It showed no significant difference in GCS at admission between the propofol and the sevoflurane groups among craniotomy patients ( = 0.75, 95%: -0.55 to 2.05, = 0.260). However, elevation in GCS from baseline was 1.73 points (95%: -2.81 to -0.66, = 0.002) less in the sevoflurane group than that in the propofol group on postoperative day 1, 2.03 points (95%: -3.14 to -0.91, < 0.001) less on day 3, and 1.31 points (95%: -2.43 to -0.19, = 0.022) less on day 7. The risk of unfavorable GOS (GOS 1, 2, and 3) at discharge was higher in the sevoflurane group ( = 4.93, 95%: 1.05 to 23.03, = 0.043). No significant difference was observed among two-group decompressive craniectomy patients in GCS and GOS.Conclusions Compared to propofol, sevoflurane was associated with worse neurological recovery during the hospital stay in TBI patients undergoing craniotomy. This difference was not detected in TBI patients undergoing decompressive craniectomy.
目的 探讨丙泊酚和七氟醚对创伤性脑损伤（TBI）患者术后早期神经功能恢复的影响。方法 回顾性分析行开颅手术或去骨瓣减压术的TBI患者的临床资料。采用广义相加混合模型（GAMM）分析丙泊酚和七氟醚对术后第1、3和7天格拉斯哥昏迷量表（GCS）的影响。采用多因素回归分析两种麻醉药对出院时格拉斯哥预后量表（GOS）的影响。结果 本研究共纳入340例TBI患者。其中110例行开颅手术，丙泊酚组75例，七氟醚组35例；134例行去骨瓣减压术，丙泊酚组63例，七氟醚组71例。开颅手术患者中，丙泊酚组和七氟醚组入院时GCS无显著差异（ = 0.75，95%：-0.55至2.05， = 0.260）。然而，术后第1天七氟醚组GCS较基线升高值比丙泊酚组少1.73分（95%：-2.81至-0.66， = 0.002），第3天少2.03分（95%：-3.14至-0.91， < 0.001），第7天少1.31分（95%：-2.43至-0.19， = 0.022）。七氟醚组出院时不良GOS（GOS 1、2和3）风险更高（ = 4.93，95%：1.05至23.03， = 0.043）。两组去骨瓣减压术患者GCS和GOS无显著差异。结论 与丙泊酚相比，七氟醚与开颅手术的TBI患者住院期间神经功能恢复较差有关。而去骨瓣减压术的TBI患者未发现这种差异。
