异丙酚与地氟醚在烟雾病患者中的对照研究

Ronak R. Ankolekar, Kirandeep Kaur, Kiran Jangra, Ashish Aggarwal, Nidhi B. Panda, Hemant Bhagat, Amiya K. Barik
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引用次数: 0

摘要

摘要目的神经外科患者是选择吸入麻醉还是静脉麻醉是有争议的。地氟醚是一种脑血管扩张剂,可能有利于缺血性脑病。因此,我们计划比较地氟醚和异丙酚在烟雾病(MMD)患者中的作用,目的是比较神经系统预后。材料与方法本前瞻性先导试验经机构伦理委员会批准启动。接受血管重建手术的烟雾病患者被随机分为两组,术中使用地氟醚或异丙酚。出院时使用改良Rankin评分(mRS)和1个月时使用扩展格拉斯哥评分(GOS-E)评估神经学预后。比较术中参数,包括血流动力学参数、潮末二氧化碳、熵、术中脑松弛评分(BRS)和脑松弛抢救措施。统计分析采用Kolmogorov-Smirnov正态性检验定量数据的正态性。正态分布数据采用非配对t检验,偏态数据采用Mann-Whitney U检验,分类变量采用卡方检验。结果随机抽取17例患者,地氟醚组10例,异丙酚组7例。地氟醚组和异丙酚组的mRS(1.3±0.6和1.14±0.4,p = 0.450)和GOS-E(6.7±0.6和6.85±0.5,p = 0.45)具有可比性。地氟醚组BRS(3.6±0.5)显著高于异丙酚组(2.1±0.3,p = 0.001),且地氟醚组需要采取抢救措施的患者数量显著(70%,p <0.001)。其他结局参数具有可比性(p >0.05)。结论:我们的结论是,在接受血管重建手术的烟雾病患者中,术后神经系统预后与使用麻醉剂地氟醚或异丙酚相当。异丙酚维持麻醉有明显优越的手术野条件。
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Propofol versus Desflurane in Moyamoya Disease Patients—A Pilot Study
Abstract Objectives The choice of inhalational or intravenous anesthetic agents is debatable in neurosurgical patients. Desflurane, a cerebral vasodilator, may be advantageous in ischemic cerebral pathologies. Hence, we planned to compare desflurane and propofol in patients with moyamoya disease (MMD) with the objective of comparing neurological outcomes. Materials and Methods This prospective pilot trial was initiated after institutional ethics committee approval. Patients with MMD undergoing revascularization surgery were randomized into two groups receiving either desflurane or propofol intraoperatively. Neurological outcomes were assessed using a modified Rankin score (mRS) at discharge and an extended Glasgow outcome score (GOS-E) at 1 month. Intraoperative parameters, including hemodynamic parameters, end-tidal carbon dioxide, entropy, intraoperative brain relaxation scores (BRS), and rescue measures for brain relaxation, were compared. Statistical Analysis The normality of quantitative data was checked using Kolmogorov–Smirnov tests of normality. Normally distributed data were compared using unpaired t-tests, skewed data using Mann–Whitney U tests, and categorical variables using chi-squared tests. Results A total of 17 patients were randomized, 10 in the desflurane and 7 in the propofol group. mRS (1.3 ± 0.6 and 1.14 ± 0.4, p = 0.450) and GOS-E (6.7 ± 0.6 and 6.85 ± 0.5, p = 0.45) were comparable between desflurane and propofol groups, respectively. BRS was significantly higher in the desflurane group (3.6 ± 0.5) compared to the propofol group (2.1 ± 0.3, p = 0.001), with a significant number of patients requiring rescue measures in the desflurane group (70%, p < 0.001). Other outcome parameters were comparable (p > 0.05). Conclusion We conclude that postoperative neurological outcomes were comparable with using either an anesthetic agent, desflurane, or propofol in MMD patients undergoing revascularization surgery. Maintenance of anesthesia with propofol had significantly superior surgical field conditions.
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