The effect of anesthetic agents on cerebral vasospasms after subarachnoid hemorrhage: A retrospective study.
The effect of anesthetic agents on cerebral vasospasms after subarachnoid hemorrhage: A retrospective study.
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DOI：
10.1097/md.0000000000011666
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发表时间：
2018-08
期刊：
影响因子：
1.6
通讯作者：
Seo EK
中科院分区：
文献类型：
--
作者：
Lee JW;Woo JH;Baik HJ;Kim DY;Chae JS;Yang NR;Seo EK
脑血管痉挛是动脉瘤夹闭术后早期发病的最重要原因。本回顾性研究的目的是评价使用丙泊酚或地氟烷进行紧急动脉瘤夹闭术时血管痉挛的发生率是否不同。分析了102例患者（丙泊酚组50例，地氟烷组52例）的数据。比较两组术后14 d内经颅多普勒、血管造影及脑梗死的发生率。记录术后数据，包括术后第14天的格拉斯哥昏迷量表（GCS）评分和术后3个月的格拉斯哥结局量表（GOS）评分。术中接受丙泊酚维持麻醉的患者，经颅多普勒（TCD）明显血管痉挛的发生率高于接受地氟烷的患者（54% vs 30.8%，P = 0.027）。 校正混杂因素后，丙泊酚组TCD明显血管痉挛的发生率仍高于地氟烷组（比值比：2.84; 95%置信区间：1.12-7.20）。然而，两组之间血管造影性血管痉挛、脑梗死和脑血管痉挛治疗干预的发生率相似。两组术后第14天的GCS评分和3个月时的GOS评分相似。未观察到麻醉剂对血管造影性血管痉挛、脑梗死或临床结局的影响，而地氟烷麻醉与丙泊酚麻醉相比，TCD明显血管痉挛的发生率较低。我们的研究为在更大的患者人群中进行进一步的随机对照研究提供了基础，以阐明麻醉剂对脑血管痉挛发生的影响。
Cerebral vasospasm is the most important cause of morbidity after an aneurysm clipping in the early postoperative period. The aim of this retrospective study was to evaluate whether the incidence of vasospasms differs when using propofol or desflurane for an emergent aneurysm clipping. The data from 102 patients (50 in the propofol group, 52 in the desflurane group) were analyzed. The occurrence of vasospasm based on daily transcranial Doppler, angiography, and cerebral infarction during 14 days after surgery were compared by anesthetic agents. Postoperative data including Glasgow Coma Scale (GCS) score on day 14 after surgery, and the Glasgow Outcome Scale (GOS) score at 3 months were documented. Patients that intraoperatively received propofol for anesthesia maintenance, had higher incidence of transcranial Doppler (TCD)-evident vasospasm than those that received desflurane (54% vs 30.8%, P = .027). The occurrence of TCD-evident vasospasm was still higher (odds ratio: 2.84; 95% confidence interval: 1.12–7.20) in the propofol group than in the desflurane group after adjusting for confounding factors. However, the incidence of angiographic vasospasm, cerebral infarction, and interventions to treat cerebral vasospasms were similar between both groups. GCS score on day 14 after surgery and the GOS score at 3 months were similar between groups. No effect of anesthetic agents on angiographic vasospasm, cerebral infarction, or clinical outcome was observed, whereas desflurane anesthesia was associated with a lower incidence of TCD-evident vasospasms compared to propofol anesthesia. Our study provides a basis for further randomized controlled studies in a larger patient population to clarify the effects of anesthetic agents on the occurrence of cerebral vasospasms.