Effects of Volatile Anesthetics on Postoperative Ischemic Stroke Incidence.
Effects of Volatile Anesthetics on Postoperative Ischemic Stroke Incidence.
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DOI：
10.1161/jaha.120.018952
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发表时间：
2021-03
影响因子：
5.4
通讯作者：
Eikermann M
中科院分区：
文献类型：
--
作者：
Raub D;Platzbecker K;Grabitz SD;Xu X;Wongtangman K;Pham SB;Murugappan KR;Hanafy KA;Nozari A;Houle TT;Kendale SM;Eikermann M
临床前研究表明，挥发性麻醉剂可减少梗死面积，改善缺血性脑卒中的预后。本研究旨在确定它们在非心脏手术中对术后缺血性脑卒中发生率的影响。这是一项回顾性队列研究，研究对象是2005年10月至2017年9月在马萨诸塞州波士顿的2个三级医疗中心接受全身麻醉的手术患者。排除标准包括脑死亡、年龄<18岁、心脏手术和缺少协变量数据。暴露量定义为术中所有地氟烷、七氟烷和异氟烷测量值经年龄调整后的最小肺泡浓度中位数。主要终点为术后30天内缺血性卒中。在314932例患者中，1957例（0.6%）出现了主要结局。高剂量的挥发性麻醉药对术后缺血性卒中的发生率有保护作用（每1个最小肺泡浓度增加的校正优势比为0.49,95% CI为0.40-0.59，P<0.001）。在Cox比例风险回归中，术后17天观察到效果(术后第1天：风险比（HR）， 0.56；95% ci, 0.48-0.65；与第17天相比，HR为0.85；95% ci, 0.74-0.99)。挥发性麻醉剂也与较低的卒中严重程度相关：最低肺泡浓度每增加1个单位，美国国立卫生研究院卒中量表就会降低0.006个单位（95% CI, - 0.01至- 0.002，P=0.002）。在各种敏感性分析中，包括麻醉提供者作为随机效应的调整，效果是稳健的。在接受非心脏手术的患者中，挥发性麻醉剂对术后早期缺血性卒中的发生率和严重程度显示出剂量依赖性的保护作用。
Preclinical studies suggest that volatile anesthetics decrease infarct volume and improve the outcome of ischemic stroke. This study aims to determine their effect during noncardiac surgery on postoperative ischemic stroke incidence. This was a retrospective cohort study of surgical patients undergoing general anesthesia at 2 tertiary care centers in Boston, MA, between October 2005 and September 2017. Exclusion criteria comprised brain death, age <18 years, cardiac surgery, and missing covariate data. The exposure was defined as median age‐adjusted minimum alveolar concentration of all intraoperative measurements of desflurane, sevoflurane, and isoflurane. The primary outcome was postoperative ischemic stroke within 30 days. Among 314 932 patients, 1957 (0.6%) experienced the primary outcome. Higher doses of volatile anesthetics had a protective effect on postoperative ischemic stroke incidence (adjusted odds ratio per 1 minimum alveolar concentration increase 0.49, 95% CI, 0.40–0.59, P<0.001). In Cox proportional hazards regression, the effect was observed for 17 postoperative days (postoperative day 1: hazard ratio (HR), 0.56; 95% CI, 0.48–0.65; versus day 17: HR, 0.85; 95% CI, 0.74–0.99). Volatile anesthetics were also associated with lower stroke severity: Every 1‐unit increase in minimum alveolar concentration was associated with a 0.006‐unit decrease in the National Institutes of Health Stroke Scale (95% CI, −0.01 to −0.002, P=0.002). The effects were robust throughout various sensitivity analyses including adjustment for anesthesia providers as random effect. Among patients undergoing noncardiac surgery, volatile anesthetics showed a dose‐dependent protective effect on the incidence and severity of early postoperative ischemic stroke.