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摘要：
目的 比较丙泊酚或七氟醚维持麻醉对颅脑创伤（traumatic brain injury, TBI）患者住院期间生存率及格拉斯哥预后评分（Glasgow Outcome Scale, GOS）的影响。 方法 回顾性分析2015年12月至2019年6月于首都医科大学附属北京天坛医院在丙泊酚或七氟醚维持麻醉下行开颅血肿清除术的TBI患者244例（丙泊酚组138例，七氟醚组106例）。收集两组人口学资料及围手术期相关指标，应用单因素分析和多元回归分析丙泊酚或七氟醚维持麻醉对TBI患者住院期间生存率及GOS不良转归率的影响。 结果 与丙泊酚组比较，七氟醚组患者入院格拉斯哥昏迷评分（Glasgow Coma Scale, GCS）较低，七氟醚组行去骨瓣减压术的患者较多，术中失血量较多，GOS不良转归率较高（P<0.05）。单因素分析发现，TBI患者年龄、入院诊断（硬膜外血肿、硬膜下血肿、弥漫性脑肿胀及脑挫裂伤）、入院GCS、入院颅脑CT基底池受压及中线移位程度、入院瞳孔反应、手术方式及术中液体出入量（晶体液、胶体液、自体血、异体红细胞、异体血浆、失血量及尿量）与患者住院期间生存率及GOS不良转归率密切相关（P<0.05）。多元回归分析显示，调整年龄、性别、BMI、入院诊断、GCS、入院颅脑CT所示基底池受压和中线移位情况、入院瞳孔反应、手术方式、术中液体出入量等混杂因素后，丙泊酚组与七氟醚组间住院期间生存率［比值比（odds ratio, OR）=2.02, 95%CI 0.81~5.02, P=0.13］、GOS不良转归率（OR=1.50, 95%CI 0.72~3.13, P=0.28）差异无统计学意义。 结论 与丙泊酚维持麻醉比较，七氟醚维持麻醉对TBI患者术后转归无不良影响，七氟醚与丙泊酚一样可安全地用于TBI患者。
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Abstract: Objective To compare the impacts of propofol‑based anesthesia and sevoflurane‑based anesthesia on in‑hospital survival rate and Glasgow Outcome Scale (GOS) in patients with traumatic brain injury (TBI). Methods A retrospective analysis was performed on 244 patients with TBI underwent craniotomy with propofol‑ or sevoflurane‑based anesthesia in Beijing Tiantan Hospital, Capital Medical University from December 2015 to June 2019 (138 in the propofol group and 106 in the sevoflurane group). Demographic data and perioperative indicators of the two groups were collected, univariate analysis and multiple regression analysis were used to analyze the impacts of propofol‑ or sevoflurane‑based anesthesia on in‑hospital survival rate and GOS adverse outcome rate of TBI patients. Results Compared with the propofol group, patients in the sevoflurane group had lower the hospital Glasgow Coma Scale (GCS), and more patients underwent decompressive craniectomy and more intraoperative blood loss, and GOS adverse outcome rate was higher (P<0.05). Univariate analysis found that, age, the hospital diagnosis (epidural hematoma, subdural hematoma, diffuse brain swelling and cerebral contusion and laceration), the hospital GCS, the hospital craniocerebral computer tomography (CT) scan, the compression of basal cistern, shift of the midline situation, the pupil diameter, surgical procedure, intraoperative fluid management (crystal fluid, colloid fluid, autologous blood, allogeneic red blood cell, allogeneic plasma, blood loss and urine volume) were closely correlated with survival rate and GOS adverse outcome rate (P<0.05). Multiple regression analysis showed that, adjustment for age, sex, body mass index (BMI), the hospital diagnosis, the hospital GCS, the hospital craniocerebral CT scan, the compression of basal cistern, shift of the midline situation, the pupil diameter, surgical procedure, intraoperative fluid management and other confounding factors, no significant difference between sevoflurane group and propofol group survival rate [odds ratio (OR)=2.02, 95% confidence interval (CI) 0.81‒5.02, P=0.13] and GOS adverse outcome rate (OR=1.50, 95%CI 0.72‒3.13, P=0.28). Conclusions Compared with propofol‑based anesthesia, sevoflurane‑based anesthesia has no adverse effects on survival rate and GOS after surgery in TBI patients. Sevoflurane is as safe as propofol.
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