术中使用氙气预防体外循环下心脏手术后谵妄：随机单盲对照临床试验
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Intraoperative xenon for prevention of delirium after on-pump cardiac surgery: a randomised, observer-blind, controlled clinical trial
背景与目的
老年患者施行心脏手术发生术后谵妄（POD）的风险为40~60%，这与发病率和死亡率增加有关。动物实验发现氙具有神经保护作用，但氙对人类的神经保护作用知之甚少。本研究旨在评估氙气麻醉是否可预防心脏手术患者发生POD。
方 法
我们进行了一项随机、观察者单盲、对照试验，共收集了190例65岁及以上接受体外循环心脏手术的患者，并随机分配为氙气麻醉组或七氟醚麻醉组。体外循环期间泵注丙泊酚用于麻醉维持。术后5天内，采用混淆评估法(CAM)进行3分钟诊断性访谈或对ICU患者使用CAM版本 (CAM-ICU)，每日对受试者进行POD筛查。其他检测谵妄的方法包括图表回顾等。次要结果包括POD的持续时间和严重程度，以及术后认知功能。
结 果
POD的总体发生率为41%(78/190)。氙气麻醉组与七氟醚麻醉组的POD发生率无统计学差异(42.7% [41/96] vs 39.4% [37/94]，P=0.583)。氙气与七氟醚比较时，POD的比值比为1.18(95%CI 0.65~2.16)。
结 论
在接受心脏手术的老年患者中，氙气麻醉并没有使POD的发生率显著降低。基于这一结果，并不推荐使用氙气来减少术后谵妄。
原始文献摘要
Al Tmimi L, Verbrugghe P, Van de Velde M,et al. Intraoperative xenon for prevention of delirium after on-pump cardiac surgery: a randomised, observer-blind, controlled clinical trial.[J].Br J Anaesth,2020 Jan 28. pii: S0007-0912(19)31025-6. doi: 10.1016/j.bja.2019.11.037.
Background: Older patients undergoing cardiac surgery have a 40~60% risk of developing postoperative delirium (POD), which is associated with increased morbidity and mortality. In animals, xenon has been found to be neuroprotective. Little is known about its neuroprotective effects in humans. We evaluated whether xenon anaesthesia prevents POD in patients undergoing cardiac surgery.
Methods: We conducted a randomised, observer-blind, controlled trial in which 190 patients 65 yr or older undergoing on-pump cardiac surgery were randomly allocated to xenon or sevoflurane anaesthesia. During cardiopulmonary bypass, propofol infusion was used for anaesthetic maintenance. Subjects were screened for POD daily during the first 5 postoperative days using the 3-Minute Diagnostic Interview for Confusion Assessment Method (CAM) or with a CAM version for patients in ICU (CAM-ICU). Other methods to detect delirium, such as chart review, were also used. Secondary outcomes included the duration and severity of POD, and postoperative cognitive function.
Results: The overall incidence of POD was 41% (78/190). There was no statistically significant difference in the POD incidence between the xenon and sevoflurane groups (42.7% [41/96] vs 39.4% [37/94], P=0.583). The odds ratio for POD when comparing xenon with sevoflurane was 1.18 (95% confifidence interval, 0.65~2.16).
Conclusions: In older patients undergoing cardiac surgery, xenon anaesthesia did not result in a significant reduction in POD. Based on these results alone, use of xenon cannot be recommended for this purpose.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：冯玉蓉 编辑：冯玉蓉 审校：王贵龙