高齢がん患者の術後認知機能障害に対するセボフルランとプロポフォール麻酔の影響。二重盲検無作為化対照試験

Impact of Sevoflurane Versus Propofol Anesthesia on Post-Operative Cognitive Dysfunction in Elderly Cancer Patients: A Double-Blinded Randomized Controlled Trial.

• Liang Guo
• Fei Lin
• Huijun Dai
• Xueke Du
• Meigang Yu
• Jinxi Zhang
• Huimei Huang
• Wanyun Ge
• Guanghua Tao
• Linghui Pan

抄録

背景 セボフルランによる麻酔を受けた外科患者の臨床転帰、およびセボフルランと術後認知機能障害（POCD）との関連性に関する研究は少ない。高齢のがん患者を対象に、セボフルランを用いた麻酔がプロポフォールを用いた麻酔と比較してPOCDの発生率を増加させ、予後を悪化させるかどうかを評価した。材料および方法 この単施設、前向き二重盲検ランダム化比較試験には、手術中にセボフルランベース（S群）またはプロポフォールベース（P群）の麻酔を受けた65～86歳の腫瘍切除術を受けた234人の患者が含まれていた。手術前、術後7日目および3ヵ月後の認知機能を評価するために一連の神経心理学的検査を実施し、その結果を健常対照群と比較した。結果 術後7日目のPOCDの発症率は、手術中にセボフランベースの麻酔を受けた患者とプロポフォールベースの麻酔を受けた患者の間に有意な差はなかった。S群は29.1％（110人中32人）、P群は27.3％（110人中30人）であり、P=0.764であった。術後3ヶ月の時点では、S群は11.3％（106例中12例）、P群は9.2％（109例中10例）、P=0.604であった。術後最初の2日間のQoR-40グローバルスコアは、S群がP群に比べて有意に低かった［POD 1：P=0.004、POD 2：P=0.001］。結論 セボフルランを用いた麻酔は、プロポフォールを用いた麻酔に比べて術後7日目、3ヶ月目のPOCDの発症率を増加させず、短期的な術後予後にも影響を与えなかった。

BACKGROUND Research on the clinical outcomes of surgical patients anaesthetized with sevoflurane and the association of sevoflurane with post-operative cognitive dysfunction (POCD) is scarce. We evaluated whether sevoflurane-based anesthesia increased the incidence of POCD and worsened prognosis compared to propofol-based anesthesia in elderly cancer patients. MATERIAL AND METHODS This single-center, prospective, double-blind randomized controlled trial included 234 patients aged 65 to 86 years undergoing tumor resection who received sevoflurane-based (Group S) or propofol-based (Group P) anesthesia during surgery. A series of neuropsychological tests was performed to evaluate cognitive function before surgery and at 7 days and 3 months post-operation, and the results were compared to those of healthy controls. RESULTS At 7 days post-operation there were no significant differences in the incidence of POCD between patients who received sevoflurane-based or propofol-based anesthesia during surgery: Group S was at 29.1% (32 out of 110 patients) versus Group P at 27.3% (30 out of 110), P=0.764. At 3 months, Group S was at 11.3% (12 out of 106 patients) versus Group P at 9.2% (10 out of 109), P=0.604. During the first 2 days post-operation, the QoR-40 global score was significantly lower in Group S compared to Group P [POD 1: P=0.004; POD 2: P=0.001]. There were no significant differences in in-hospital post-operative complications, post-operative length of hospital stay, all-cause mortality at 30 days, and 3 months post-operation, or post-operative quality of life at 3 months between patients in Group S and Group P. CONCLUSIONS Sevoflurane-based anesthesia did not increase the incidence of POCD compared to propofol-based anesthesia at 7 days or 3 months post-operation or impact short-term post-operative prognosis.