麻醉药影响创伤后应激障碍吗？

创伤后应激障碍（Posttraumatic stress disorder， PTSD）是创伤后常见的严重后果之一，会对患者造成严重影响。

PTSD是指个体经历、目睹或遭遇到一个或多个涉及自身或他人的实际死亡，或受到死亡的威胁，或严重的受伤，或躯体完整性受到威胁后，所导致的个体延迟出现和持续存在的精神障碍。

创伤患者多需手术麻醉，麻醉药物会对PTSD产生怎样的影响呢？

有学者总结了300例创伤急诊手术病例，结果如何呢？

摘要译文

七氟醚和异丙酚对急诊创伤后应激障碍的影响：

一项双盲随机对照试验

目的：

创伤后应激障碍（PTSD）是创伤事件的常见致残后果。

此前的一项研究发现，早期使用异丙酚是PTSD的潜在危险因素。

本前瞻性研究旨在探讨异丙酚和七氟醚对创伤患者急诊手术后PTSD的影响。

方法：

将300例接受急诊手术的创伤患者随机分为两组，分别用异丙酚和/或七氟醚麻醉。

收集围手术期临床资料。

术后1个月，两组患者的PTSD发生率均采用临床医生管理的DSM-5 PTSD量表（CAPS-5）进行评估。

受伤时间和CAPS-5评分的相关性通过Spearman相关分析进行评估。

采用Logistic回归分析PTSD的危险因素。

结果：

术后1个月，异丙酚组PTSD的发生率高于七氟醚组（23.2%对12.2%，P=0.014）。

异丙酚组的损伤时间与CAPS-5评分呈负相关（r=-0.226，P<0.001）。

在逻辑回归分析中，异丙酚的使用是PTSD的独立危险因素（P=0.017）。

结论：

创伤患者急诊手术早期应用异丙酚全麻可能会增加PTSD的风险。

原文摘要

Effects of Sevoflurane and Propofol on Posttraumatic Stress Disorder After Emergency Trauma:

 A Double-Blind Randomized Controlled Trial

Objective: 

Posttraumatic stress disorder (PTSD) is a frequent and disabling consequence of traumatic events. 

A previous study found that early use of propofol was a potential risk factor for PTSD. 

This prospective study aimed to investigate the effect of propofol and sevoflurane on PTSD after emergency surgery in trauma patients.

Methods: 

A total of 300 trauma patients undergoing emergency surgery were randomly divided into two groups and anesthetized with propofol and/or sevoflurane. 

Perioperative clinical data were collected. The incidence of PTSD was evaluated with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) in the two groups 1 month after the operation. 

The relevance of the injury time and CAPS-5 scores was assessed by Spearman correlation analysis. Logistic regression analysis was used to analyze the risk factors for PTSD.

Results: 

The incidence of PTSD in the propofol group was higher than that in the sevoflurane group 1 month postoperatively (23.2 vs. 12.2%, P = 0.014). 

The injury time was negatively correlated with the CAPS-5 score in the propofol group (r = -0.226, P < 0.001). 

In the logistic regression analysis, the utilization of propofol was an independent risk factor for PTSD (P = 0.017).

Conclusion: 

Early use of propofol general anesthesia in emergency surgery for trauma patients may increase the risk of PTSD.

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