[1]彭山攀,杨 菲,郭黎登,等.术中麻醉维持方式对老年患者围术期神经认知障碍影响的Meta分析[J].医学信息,2023,36(09):67-73.[doi:10.3969/j.issn.1006-1959.2023.09.012]
　PENG Shan-pan,YANG Fei,GUO Li-deng,et al.Meta-analysis of the Effect of Intraoperative Anesthesia Maintenance on Perioperative Neurocognitive Disorders in Elderly Patients[J].Journal of Medical Information,2023,36(09):67-73.[doi:10.3969/j.issn.1006-1959.2023.09.012]
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术中麻醉维持方式对老年患者围术期神经认知障碍影响的Meta分析()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
36卷
期数:
2023年09期
页码:
67-73
栏目:
论著
出版日期:
2023-05-01

文章信息/Info

Title:
Meta-analysis of the Effect of Intraoperative Anesthesia Maintenance on Perioperative Neurocognitive Disorders in Elderly Patients
文章编号:
1006-1959（2023）09-0067-07
作者:
彭山攀; 杨 菲; 郭黎登; 等
（1.广东医科大学第一临床医学院，广东 湛江 524023；2.南方医科大学附属东莞医院麻醉科，广东 东莞 523059；3.南方医科大学第一临床学院，广东 广州 510515）
Author(s):
PENG Shan-pan; YANG Fei; GUO Li-deng; et al.
(1.The First Clinical Medical College of Guangdong Medical University,Zhanjiang 524023,Guangdong,China;2.Department of Anesthesiology,Dongguan Hospital Affiliated to Southern Medical University,Dongguan 523059,Guangdong,China; 3.The First Clinical College of Southern Medical University,Guangzhou 510515,Guangzhou,China)
关键词:
吸入麻醉; 老年患者; 围术期神经认知障碍
Keywords:
Inhalation anesthesia; Elderly patients; Perioperative neurocognitive disorders
分类号:
R619
DOI:
10.3969/j.issn.1006-1959.2023.09.012
文献标志码:
A
摘要:
目的 探讨术中麻醉维持方式对老年患者围术期神经认知障碍的影响。方法 通过检索Cochrane Library、PubMed、EMbase、中国知网、万方、维普等数据库，收集建库至2021年9月有关吸入麻醉、静脉麻醉对老年患者围术期神经认知障碍影响的临床随机对照试验，进行文献筛选，质量评价，资料提取，并采用Stata 15.1和RevMan5.4.1软件进行Meta分析。结果 最终纳入9项随机对照试验，共计698例观察对象，其中吸入麻醉组348例，静脉麻醉组350例。结果显示：术前和术后第7天，两组患者认知功能比较，差异无统计学意义[SMD=-0.10，95%CI（-0.35~0.15），P=0.45]、[SMD=0.72，95%CI（-0.12~1.57），P=0.09]；术后3 d内（＜24、24~72 h）吸入麻醉组的MMSE评分低于静脉麻醉组[SMD=-0.79，95%CI（-1.05~-0.52），P＜0.00001]、[SMD=-0.15，95%CI（-0.26~-0.05），P=0.004]。结论 术中使用吸入药物和静脉药物维持麻醉都引起术后72 h内老年患者认知功能下降，其中以术后24 h内吸入麻醉组降低更为明显。7 d后两组患者认知功能均恢复术前水平。
Abstract:
Objective To investigate the effect of intraoperative anesthesia maintenance on perioperative neurocognitive disorders in elderly patients.Methods By searching Cochrane library, PubMed, Embase, China National Knowledge Infrastructure database(CNKI), WanFang Data, Chinese scientific journals full-text database (VIP), and other databases, clinical randomized controlled trials on the effects of inhalation anesthesia and intravenous anesthesia on perioperative neurocognitive disorders in elderly patients from the establishment of the database to September 2021 were collected. Literature screening, quality evaluation, data extraction, and meta-analysis were performed using Stata 15.1 and RevMan 5.4.1 software.Results Finally, 9 randomized controlled trials were included, with a total of 698 subjects, including 348 subjects in the inhalation anesthesia group and 350 subjects in the intravenous anesthesia group. The results showed that there was no significant difference in cognitive function between the two groups before and 7 days after operation [SMD=-0.10,95%CI(-0.35-0.15),P=0.45], [SMD=0.72,95%CI(-0.12-1.57),P=0.09]; the MMSE score of the inhalation anesthesia group was lower than that of the intravenous anesthesia group within 3 days after operation (<24, 24-72 h) [SMD=-0.79,95%CI(-1.05--0.52),P<0.00001],[SMD=-0.15,95%CI(-0.26--0.05),P=0.004 ].Conclusion The use of inhaled drugs and intravenous drugs to maintain anesthesia during operation can cause cognitive decline in elderly patients within 72 hours after operation, and the decrease is more obvious in the inhalation anesthesia group within 24 hours after operation. After 7 days, the cognitive function of the two groups recovered to the preoperative level.

参考文献/References:

[1]Doherty HR,Wong J.The Perioperative Neurocognitive Disorders[J].Anesthesia & Analgesia,2020,130(1):e23.[2]Paredes S,Cortínez L,Contreras V,et al.Post-operative cognitive dysfunction at 3 months in adults after non-cardiac surgery: a qualitative systematic review[J].Acta Anaesthesiologica Scandinavica,2016,60(8):1043-1058.[3]Olotu C.Postoperative neurocognitive disorders[J].Current Opinion in Anaesthesiology,2020,33(1):101-108.[4]Miller D,Lewis SR,Pritchard MW,et al.Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery (Review)[J].Cochrane Database Syst Rev,2018,8(8):D12317.[5]Evered L,Silbert B,Knopman DS,et al.Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018[J]. British Journal of Anaesthesia,2018,121(5):1005-1012.[6]何巍,马隽,李洋.丙泊酚及血清载脂蛋白E基因对老年术后认知障碍的影响[J].中国老年学杂志,2019,39(5):1102-1104.[7]王莉,唐珩,张培俊,等.不同麻醉药物对老年患者术后认知功能及炎性因子的影响[J].中国处方药,2016,14(7):97-98.[8]王飒.分析丙泊酚与气体麻醉对老年患者术后认知功能障碍的影响[J].中国卫生标准管理,2015,6(18):186-187.[9]钱万新.静脉麻醉与吸入麻醉对老年患者术后认知功能的影响对比[J].基层医学论坛,2015,19(26):3624-3625.[10]朱利斌,胡晓斌.七氟烷吸入麻醉对老年腹腔镜胆囊切除术患者术后认知功能障碍及应激反应影响的研究[J].浙江创伤外科,2018,23(1):184-186.[11]张俊峰.全凭静脉麻醉与吸入麻醉对老年患者术后认知功能的影响对比分析[J].中外医学研究,2015,13(7):58-59.[12]周晓锋,陈远声,陈丽欢,等.老年骨科患者吸入麻醉术后认知功能障碍的临床研究[J].中国医药科学,2019,9(3):92-95.[13]沈耀峰,吴镜湘,徐美英.丙泊酚和七氟烷麻醉对老年患者普通胸外科手术后认知功能的影响[J].上海交通大学学报(医学版),2011,31(3):322-325.[14]刘叶,李红,刘枝,等.不同麻醉方式对老年女性腹腔镜手术患者术后认知功能的影响[J].河北医科大学学报,2021,42(7):846-850.[15]Sun H,Zhang G,Ai B,et al.A systematic review: comparative analysis of the effects of propofol and sevoflurane on postoperative cognitive function in elderly patients with lung cancer[J].BMC Cancer,2019,19(3):1248.[16]Li Y,Chen D,Wang H,et al.Intravenousversus Volatile Anesthetic Effects on Postoperative Cognition in Elderly Patients Undergoing Laparoscopic Abdominal Surgery[J].Anesthesiology,2021,134(3):381-394.[17]Miller AL,Theodore D,Widrich J.Inhalational Anesthetic[M].StatPearls Publishing,Treasure Island (FL),2020.[18]Colonna M,Butovsky O.Microglia Function in the Central Nervous System During Health and Neurodegeneration[J].Annu Rev Immunol,2017,35:441-468.[19]Xiang X,Yu Y,Tang X,et al.Transcriptome Profile in Hippocampus During Acute Inflammatory Response to Surgery:Toward Early Stage of PND[J].Front Immunol,2019,10:149.[20]Niu W,Ma L,Tao T,et al.Surgery-induced cognitive dysfunction is alleviated through triggering receptor expressed on myeloid cells 2[J].Acta Histochem,2020,122(5):151553.[21]Subramaniyan S,Terrando N.Neuroinflammation and Perioperative NeurocognitiveDisorders[J]. Anesthesia & Analgesia,2019,128(4):781-788.

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更新日期/Last Update: 1900-01-01