【罂粟摘要】吸入麻醉与全凭静脉麻醉对术后认知功能障碍发生率影响的比较：一项系统回顾和Meta分析

吸入麻醉与全凭静脉麻醉对术后认知功能障碍发生率影响的比较：一项系统回顾和Meta分析

贵州医科大学     麻醉与心脏电生理课题组

翻译：吴学艳  编辑：陈锐  审核：曹莹

罂 粟 摘 要 

摘要：

术后认知功能障碍(POCD)已被越来越多的人认为是导致术后并发症的原因之一；一个共识工作组建议将POCD为延迟认知功能恢复（即术后30天内的评估）和神经认知功能障碍，（即术后30天到12个月内的评估）；此外，麻醉方式的选择，无论是吸入麻醉或全凭静脉麻醉(TIVA)及其对POCD发生率的影响，已成为研究的重点。主要观察指标：通过文献检索和meta分析来验证全身麻醉方式的选择是否会影响术后30天内POCD的发生率；次要观察指标为：对相关文献进行系统回顾，以评价全身麻醉对术后30天至12个月内POCD的影响。对1913篇文章进行初步筛查后，主要观察指标最终纳入10项研究，共3390例患者；次要观察指标共纳入4项研究，共480例患者。 与吸入麻醉组相比，术后30d内,TIVA组POCD的优势比为0.46（9.5%CI=0.2 6-0.8 1，P=0.0 1），表明TIVA组术后30天内POCD的发生率较低；而次要观察指标由于纳入文章数量少且异质性高，未进行meta分析。鉴于POCD标准的异质性，未来应进行设计更为稳健的前瞻性研究以全面解决这一问题。

原始文献来源：Negrini D, Wu A, Oba A, et al. Incidence of Postoperative Cognitive Dysfunction Following Inhalational vs Total Intravenous General Anesthesia: A Systematic Review and Meta-Analysis[J]. Neuropsychiatr Dis Treat. 2022 Jul 15;18:1455-1467. DOI: 10.2147/NDT.S374416. 

英文原文 

Incidence of Postoperative Cognitive Dysfunction Following Inhalational vs Total Intravenous General Anesthesia: A Systematic Review and Meta-Analysis

Abstract

Postoperative cognitive dysfunction (POCD) has been increasingly recognized as a contributor to postoperative complications. A consensus-working group recommended that POCD should be distinguished between delayed cognitive recovery, ie, evaluations up to 30 days postoperative, and neurocognitive disorder, ie, assessments performed between 30 days and 12 months after surgery. Additionally, the choice of the anesthetic, either inhalational or total intravenous anesthesia (TIVA) and its effect on the incidence of POCD, has become a focus of research. Our primary objective was to search the literature and conduct a meta-analysis to verify whether the choice of general anesthesia may impact the incidence of POCD in the first 30 days postoperatively. As a secondary objective, a systematic review of the literature was conducted to estimate the effects of the anesthetic on POCD between 30 days and 12 months postoperative. For the primary objective, an initial review of 1913 articles yielded ten studies with a total of 3390 individuals. For the secondary objective, four studies with a total of 480 patients were selected. In the first 30 days postoperative, the odds-ratio for POCD in TIVA group was 0.46 (95% CI = 0.26-0.81; p = 0.01), compared to the inhalational group. TIVA was associated with a lower incidence of POCD in the first 30 days postoperatively. Regarding the secondary objective, due to the small number of selected articles and its high heterogeneity, a metanalysis was not conducted. Given the heterogeneity of criteria for POCD, future prospective studies with more robust designs should be performed to fully address this question.