Feng Yunying, Zhang Yuelun, Lian Wei, Xue Yang, Ma Manjiao, Yu Xuerong, Guo Xiaopeng, Ma Lulu, Xing Bing, Huang Yuguang
Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
Joint Laboratory of Anesthesia and Pain, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
BMC Anesthesiol. 2025 Aug 4;25(1):392. doi: 10.1186/s12871-025-03263-z.
The effects of inhalation anesthesia as compared with total intravenous anesthesia (TIVA) on postoperative recovery quality in patients undergoing transsphenoidal resection of pituitary adenoma have not been well studied.
This randomized clinical trial enrolled patients undergoing transsphenoidal surgery between May 2023 to April 2024. Patients were randomly assigned in a 1:1 ratio to receive inhalation anesthesia or TIVA. The primary endpoint was the 15-item Quality of Recovery Scale (QoR-15) score on the first postoperative day. Secondary endpoints included postoperative anesthesia recovery patterns, neuroendocrine stress responses, cellular immune responses, and recovery quality. Subgroup analyses were also conducted for the postoperative QoR-15 scores and neuroendocrine stress responses. Potential influence factors for QoR-15 scores and changes in counts of lymphocytes were explored.
A total of 252 patients were randomized. No significant difference in postoperative QoR-15 scores was observed between groups and the between-group difference was well below the minimal clinically important difference (median difference 1.0, 95% confidence interval [CI]- 4.0 to 5.0, P = 0.647). Compared with the inhalation group, the TIVA group exhibited significantly lower Richmond agitation-sedation scale (RASS) score and reduced antiemetic drug use in the postanesthesia care unit. Subgroup analyses for postoperative QoR-15 scores revealed no significant interactions. Adrenocorticotropic hormone levels on postoperative day 1 were lower in the inhalation group, while thyroxine and serum free thyroxine levels were higher. No significant differences in these neuroendocrine indices were found in postoperative month 3. Lymphocyte subset levels did not differ between groups on postoperative day 1, although perioperative changes in immune cell counts were correlated with patient demographic and clinical characteristics.
Both anesthesia methods resulted in comparable short-term postoperative recovery quality as measured by the QoR-15 scores. TIVA was associated with smoother anesthesia recovery and lower immediate antiemetic requirements. Differences in early neuroendocrine responses were observed but did not persist at 3 months postoperatively.
The trial is registered with the ClinicalTrials.gov platform (registration number: NCT05822817; date of registration: March 13, 2023).
与全凭静脉麻醉（TIVA）相比，吸入麻醉对垂体腺瘤经蝶窦切除术患者术后恢复质量的影响尚未得到充分研究。
这项随机临床试验纳入了2023年5月至2024年4月期间接受经蝶窦手术的患者。患者按1:1比例随机分配接受吸入麻醉或全凭静脉麻醉。主要终点是术后第一天的15项恢复质量量表（QoR-15）评分。次要终点包括术后麻醉恢复模式、神经内分泌应激反应、细胞免疫反应和恢复质量。还对术后QoR-15评分和神经内分泌应激反应进行了亚组分析。探讨了QoR-15评分和淋巴细胞计数变化的潜在影响因素。
共有252例患者被随机分组。两组术后QoR-15评分无显著差异，组间差异远低于最小临床重要差异（中位数差异1.0，95%置信区间[CI]-4.0至5.0，P = 0.647）。与吸入组相比，全凭静脉麻醉组在麻醉后护理单元的里士满躁动镇静量表（RASS）评分显著更低，且使用的止吐药物更少。术后QoR-15评分的亚组分析未发现显著交互作用。吸入组术后第1天促肾上腺皮质激素水平较低，而甲状腺素和血清游离甲状腺素水平较高。术后第3个月这些神经内分泌指标无显著差异。术后第1天两组淋巴细胞亚群水平无差异，尽管围手术期免疫细胞计数变化与患者人口统计学和临床特征相关。
两种麻醉方法在术后短期恢复质量方面（以QoR-15评分衡量）相当。全凭静脉麻醉与更平稳的麻醉恢复和更低的即时止吐需求相关。观察到早期神经内分泌反应存在差异，但术后3个月未持续存在。
该试验已在ClinicalTrials.gov平台注册（注册号：NCT05822817；注册日期：2023年3月13日）。
