目的:比较丙泊酚为基础的全静脉麻醉(TIVA)和七氟醚挥发性麻醉在择期冠状动脉旁路移植术(CABG)和体外循环(CPB)的成年患者中谵妄和术后早期(1周)认知功能障碍(POCD)的发生率。
方法:这是一项前瞻性随机单盲研究。
方法:这项研究是在单一机构进行的,SreeChitraTirunal医学科学与技术研究所,三级护理机构和大学一级的教学医院。
方法:72例CPB下择期CABG患者参与本研究。
方法:本研究对72名接受CPB下择期CABG的成年患者(>18岁)进行随机分组,接受丙泊酚或七氟醚治疗。监测麻醉深度以维持双频指数在40和60之间。使用重症监护病房的混乱评估方法评估谵妄。当蒙特利尔认知评估评分与基线相比降低>2分时,诊断为早期POCD。使用近红外光谱(NIRS)的脑氧饱和度变化,动脉粥样硬化等级,比较两组的术中变量。
结果:72例患者随机接受异丙酚(n=36)或七氟醚(n=36)。患者平均年龄为59.4±8.6岁。基线和术中变量,包括动脉粥样硬化等级,NIRS值,血红蛋白,血糖控制,和氧合,两组具有可比性。15例(21.7%)患者出现谵妄,31例患者(44.9%)有早期POCD。与异丙酚(n=3;8.8%)相比,七氟醚(n=12;34.2%)的谵妄发生率更高(比值比[OR],1.72;95%置信区间[CI],1.13-2.62;p=0.027)*。七氟醚(n=20;57.1%)高于异丙酚(n=11;32.3%)(OR,1.63;95%CI,1.01-2.62;p=0.038)*。在年龄>65岁的患者中,七氟醚组的谵妄发生率(7/11;63.6%)高于异丙酚组(1/7;14.2%)(p=0.03)*.
结论:在CPB下接受CABG的队列患者中,与七氟醚相比,基于丙泊酚的TIVA与谵妄和POCD的发生率较低相关。大规模,需要随访时间较长的多中心随机试验来证实这一观察结果的临床相关性.
OBJECTIVE: To compare the incidence of delirium and early (at 1 week) postoperative cognitive dysfunction (POCD) between propofol-based total intravenous anesthesia (TIVA) and volatile anesthesia with sevoflurane in adult patients undergoing elective coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CPB).
METHODS: This was a prospective randomized single-blinded study.
METHODS: The study was conducted at a single institution, the Sree Chitra Tirunal Institute for Medical Sciences and Technology, a tertiary care institution and university-level teaching hospital.
METHODS: Seventy-two patients undergoing elective CABG under CPB participated in this study.
METHODS: This study was conducted on 72 adult patients (>18 years) undergoing elective CABG under CPB who were randomized to receive propofol or sevoflurane. Anesthetic depth was monitored to maintain the bispectral index between 40 and 60. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit. Early POCD was diagnosed when there was a reduction of >2 points in the Montreal Cognitive Assessment score compared to baseline. Cerebral oximetry changes using near-infrared spectroscopy (NIRS), atheroma grades, and intraoperative variables were compared between the 2 groups.
RESULTS: Seventy-two patients were randomized to receive propofol (n = 36) or sevoflurane (n = 36). The mean patient age was 59.4 ± 8.6 years. The baseline and intraoperative variables, including atheroma grades, NIRS values, hemoglobin, glycemic control, and oxygenation, were comparable in the 2 groups. Fifteen patients (21.7%) patients developed delirium, and 31 patients (44.9%) had early POCD. The incidence of delirium was higher with sevoflurane (n = 12; 34.2%) compared to propofol (n = 3; 8.8%) (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.13-2.62; p = 0.027)*. POCD was higher with sevoflurane (n = 20; 57.1%) compared to propofol (n = 11; 32.3%) (OR, 1.63; 95% CI, 1.01-2.62; p = 0.038)*. In patients aged >65 years, delirium was higher with sevoflurane (7/11; 63.6%) compared to propofol (1/7; 14.2%) (p = 0.03)*.
CONCLUSIONS: Propofol-based TIVA was associated with a lower incidence of delirium and POCD compared to sevoflurane in this cohort of patients undergoing CABG under CPB. Large-scale, multicenter randomized trials with longer follow-up are needed to substantiate the clinical relevance of this observation.