应用地氟烷和七氟烷的术后呼吸并发症比较:单中心队列研究

背景：七氟烷和地氟烷是维持麻醉最常用的挥发性麻醉剂。在这项研究中，我们旨在评估挥发性麻醉剂的选择与术后早期呼吸道并发症之间的关系，并解决这两种常用药物在安全性方面的关键知识差距。

方法：我们对2005年至2018年间在我院接受七氟烷或地氟烷维持全身麻醉的成人患者（非心脏手术）进行了回顾性分析。我们评估了地氟烷暴露（与七氟烷相比）与术后呼吸并发症主要结局之间的关系，定义为拔管后早期血氧饱和度降低（SpO2<90%）或术后7天内重新插管。进行多元回归分析，并调整混杂因素，包括患者、麻醉和手术因素。采用倾向性匹配、交互作用和亚组分析来评估高危组的预后：病态肥胖（BMI>35 kg.m ）、老年人（年龄>65岁）、呼吸系统并发症的高风险以及24小时的主要转归。

结果：23830名患者使用地氟烷，84608名患者使用七氟烷。与七氟烷相比，使用地氟烷的患者术后呼吸道并发症的风险并未降低（调整后的优势比为0.99，95%CI为0.94~1.04，p=0.598）。这些发现在所有高危患者亚组和倾向评分匹配的队列中是一致的。

结论：总之，与七氟烷相比，地氟烷的使用与术后呼吸并发症的减少无关。考虑到挥发性麻醉剂的环境和成本问题，我们的研究提供了重要的数据来支持关于使用地氟烷的组织决策。

原始文献来源： Zucco L, Santer P, Levy N, et al. A comparison of postoperative respiratory complications associated with the use of desflurane and sevoflurane: a single-centre cohort study.[J].Anaesthesia. 2020 Aug 3.DOI：10.1111/anae.15203  

A comparison of postoperative respiratory complications associated with the use of desflurane and sevoflurane: a single-centre cohort study

Summary

Sevoflurane and desflurane are the most commonly used volatile anaesthetics for maintenance of anaesthesia. In this study, we aimed to evaluate the relationship between choice of volatile anaesthetic and early postoperative respiratory complications, and to address a critical knowledge gap in safety outcomes between these two commonly used agents. We performed a retrospective analysis of adult (non-cardiac surgery) patients who received sevoflurane or desflurane for the maintenance of general anaesthesia at our institution between 2005 and 2018. We evaluated the association between desflurane exposure (when compared with sevoflurane) and the primary outcome of postoperative respiratory complications, defined by early post-extubation desaturation (SpO2 < 90%) or re-intubation within 7 days postoperatively. Multivariable regression analyses were performed and adjusted for confounding factors, including patient, anaesthetic and surgical factors. Propensity matched, interaction and sub-group analyses were performed to assess outcomes in high-risk groups: morbidly obese (BMI > 35 kg.m2 ); elderly (age > 65 years); and high risk of respiratory complications as well as the primary outcome at 24 h. Desflurane was used for 23,830 patients and sevoflurane for 84,608 patients. Patients exposed to desflurane did not demonstrate a reduced risk of postoperative respiratory complications when compared with sevoflurane (adjusted odds ratio 0.99, 95%CI 0.94–1.04, p = 0.598). These findings were consistent across all sub-groups of high-risk patients and in the propensity score matched cohort. In summary, desflurane use was not associated with reduced postoperative respiratory complications when compared with sevoflurane. In the context of environmental and cost concerns with volatile anaesthetic agents, our study provides important data to support organisational decisions regarding the use of desflurane.