背景:挥发性麻醉药在临床前研究中显示出神经保护作用,但在动脉瘤性蛛网膜下腔出血(aSAH)后使用它们的临床数据有限.本研究旨在分析使用挥发性麻醉药进行神经危重护理镇静是否影响迟发性脑缺血(DCI)的发生率。脑血管痉挛(CVS),DCI相关梗死或功能结果。
方法:回顾性收集了通气性aSAH患者(2016-2022年)的数据,服用镇静剂至少180小时。为了进行比较分析,根据所使用的镇静剂将患者分为对照组和研究组(静脉注射与挥发性镇静剂)。采用Logistic回归分析确定DCI、CVS、DCI相关梗死,和功能结果。
结果:纳入99例患者,中位年龄为58岁(IQR52-65岁)。47例患者(47%)接受静脉镇静,52例患者(53%)接受了(额外)异氟烷(n=30,58%)或七氟醚(n=22,42%)的挥发性镇静,中位持续时间为169小时(范围5-298小时).两组在DCI、血管造影CVS、DCI相关梗死,或功能结果。在多变量逻辑回归分析中,挥发性麻醉药的使用对DCI相关梗死的发生率或患者的功能结局无影响.
结论:aSAH患者的挥发性镇静与DCI,CVS的发生率无关。DCI相关梗死或功能结果。虽然我们无法证明挥发性麻醉药的神经保护作用,我们的结果表明,aSAH后的挥发性镇静对患者的预后没有负面影响.
BACKGROUND: Volatile anesthetics have shown neuroprotective effects in preclinical studies, but clinical data on their use after aneurysmal subarachnoid hemorrhage (aSAH) are limited. This study aimed to analyze whether the use of volatile anesthetics for neurocritical care sedation affects the incidence of delayed cerebral ischemia (DCI), cerebral vasospasm (CVS), DCI-related infarction or functional outcome.
METHODS: Data were retrospectively collected for ventilated aSAH patients (2016-2022), who received sedation for at least 180 hours. For comparative analysis patients were assigned to a control and a study group according to the sedation used (intravenous vs. volatile sedation). Logistic regression analysis was performed to identify independent predictors of DCI, CVS, DCI-related infarction, and functional outcome.
RESULTS: 99 patients with a median age of 58 years (IQR 52-65 years) were included. 47 patients (47%) received intravenous sedation, while 52 patients (53%) received (additional) volatile sedation with isoflurane (n=30, 58%) or sevoflurane (n=22, 42%) for a median duration of 169 hours (range 5-298 hours). There were no significant differences between the two groups regarding the occurrence of DCI, angiographic CVS, DCI-related infarction, or functional outcome. In a multivariable logistic regression analysis, the use of volatile anesthetics had no impact on the incidence of DCI-related infarction or the patients\' functional outcome.
CONCLUSIONS: Volatile sedation in aSAH patients is not associated with the incidence of DCI, CVS, DCI-related infarction or functional outcome. Although we could not demonstrate neuroprotective effects of volatile anesthetics, our results suggest that volatile sedation after aSAH has no negative effect on patient\'s outcome.