七氟烷和丙泊酚对急诊外伤术后创伤后应激障碍发病的影响  

Effects of propofol and sevoflurane on post-traumatic stress disorder after emergency surgery in trauma patients

作　　者：俞又佳 张新春 李艳[1] 乔世刚[3] 朱杨子 方理超[2] 许雪飞[5] Yu Youjia;Zhang Xinchun;Li Yan;Qiao Shigang;Zhu Yangzi;Fang Lichao;Xu Xuefei(Department of Anesthesiology,Suzhou Xiangcheng People's Hospital,Suzhou 215131,China;Emergency and Critical Department,Suzhou Xiangcheng People's Hospital,Suzhou 215131,China;Department of Anesthesiology,Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou 215153,China;Anesthesiology,Xuzhou Central Hospital,Xuzhou 221009,China;Department of General surgery,Suzhou Xiangcheng People's Hospital,Suzhou 215131,China)

机构地区：[1]苏州市相城人民医院麻醉科,215131 [2]苏州市相城人民医院急重症医学科,215131 [3]南京医科大学附属苏州医院(苏州科技城医院)麻醉科,215153 [4]徐州市中心医院麻醉科,221009 [5]苏州市相城人民医院普通外科,215131

出　　处：《中华急诊医学杂志》2021年第11期1349-1352,共4页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金青年项目(81801332);苏州市科技发展项目(SYS2019025);苏州市科技发展项目(SYSD2019062)。

摘　　要：目的研究两种主要全身麻醉药物丙泊酚、七氟烷对急诊外伤患者术后创伤后应激障碍(PTSD)发病率的影响。方法选择160例在全麻下接受急诊手术的外伤患者,随机(随机数字表法)分为丙泊酚组和七氟烷组,两组患者分别使用丙泊酚和七氟烷维持麻醉,采集围手术期各项临床数据。术后1个月使用PCL-5量表评估两种患者PTSD发生率差异,分别对两组患者麻醉前受伤时间和PCL-5量表评分进行Spearman相关分析,采用logistic回归分析进一步研究PTSD发生危险因素。结果术后1个月,丙泊酚组患者PTSD发生率显著高于七氟烷组(24%vs 10.8%,P=0.034),丙泊酚组麻醉前受伤时间与PCL-5量表评分程负相关(r=0.229,P<0.01),而七氟烷组麻醉前受伤时间与PCL-5量表评分无相关性(r=0.001,P=0.804)。通过logistic回归分析发现,丙泊酚的使用是PTSD发生率的独立危险因素(P=0.004)。结论在外伤患者急诊手术中,选择七氟烷进行全身麻醉相比丙泊酚麻醉对减少术后PTSD发生具有一定应用价值。Objective To investigate the effects of propofol and sevoflurane on post-traumatic stress disorder(PTSD)after emergency surgery in trauma patients.Methods A total of 160 trauma patients undergoing emergency surgery under general anesthesia were randomly divided into the propofol group and the sevoflurane group.The perioperative clinical data of the two groups were collected.The incidence of PTSD was evaluated by PCL-5 score one month after the operation in the two groups.The relevance of the injury time and PCL-5 score was assessed by Spearman correlation analysis.Logistic regression analysis was used to analyze the risk factors of PTSD.Results The incidence of PTSD in the propofol group was significantly higher than that in the sevoflurane group at postoperative 1 month(24.0%vs 10.8%,P=0.034).The injury time was negatively correlated with PCL-5 score in the propofol group(r=0.229,P<0.01).There was no correlation between the injury time and the PCL-5 score in the sevoflurane group(r=0.001,P=0.804).Logistic regression analysis showed that the use of propofol was an independent risk factor for PTSD(P=0.004).Conclusions Sevoflurane anesthesia is more effective than propofol anesthesia in reducing the occurrence of PTSD in emergency surgery for trauma patients.

关 键 词：外伤 创伤后应激障碍 丙泊酚 七氟烷 急诊手术 

分 类 号：R614[医药卫生—麻醉学]