不同麻醉方案对老年患者的认知功能影响:一项单中心观察性研究

不同麻醉方案对老年患者的认知功能影响:一项单中心观察性研究

贵州医科大学    麻醉与心脏电生理课题组

翻译：柏雪  编辑：张中伟  审校：曹莹

背景：随着年龄的增长，老年患者术后认知能力下降的风险较高。即使采用了针对老年患者情况制定的麻醉方案，术后认知障碍的风险仍然很高。焦虑和麻醉本身会对术后认知结果产生负面影响。本研究的目的是评价全身麻醉与区域神经麻醉对老年手术患者术后认知障碍和围手术期应激指标的影响。

方法：这项单中心前瞻性研究起止时间为2014 年 12 月至 2015 年 11 月，纳入46 例年龄在 50 至 85 岁之间接受了皮肤手术的患者，根据患者实际采用的麻醉方式分为全身麻醉组和区域神经麻醉组。术后连续三天分析唾液皮质醇水平（每天三次）。在手术前一天和手术后一天通过神经心理学测试认知功能，包括记忆力、执行能力、注意力和处理速度等多项认知功能评估。

结果：区域神经麻醉组(RAG, n=28)与全身麻醉组(GAG, n=18)术后认知功能无明显差异。但GAG组的患者术后皮质醇水平明显高于RAG组。在两组中，手术当天都检测到皮质醇值的峰值，与RAG相比，GAG组的皮质醇值更高。

结论：我们没有观察到接受区域神经麻醉或全身麻醉的皮肤手术患者术后认知功能的差异。然而，我们发现RAG的皮质醇水平较低。基于这些发现，未来的研究应该探讨在全麻环境下减轻压力的替代方法。

原始文献来源：Soeren Wagner, Martin Breitkopf, Elena Ahrens,et,al. Cognitive function in older patients and their stress challenge using different anesthesia regimes: a single center observational study. BMC Anesthesiology (2023) 23:6.

英文原文   

Cognitive function in older patients and their stress challenge using different anesthesia regimes: a single center observational study

Abstract

Background With increasing age older patients are at higher risk for cognitive decline after surgery. Even tailored anesthesia procedures in older patients remain a high risk for postoperative cognitive disorder. Additional stress derived from anxiety and anesthesia itself can negatively impact postoperative cognitive outcomes. The objective of this study was to evaluate the impact of general versus regional anesthesia on postoperative cognitive disorder and indicators of perioperative stress in elderly undergoing surgery.

Methods In this single center prospective study between December 2014 and November 2015, 46 patients aged 50 to 85 years undergoing dermatology surgery were enrolled. Patients were stratified by receiving general versus regional nerve anesthesia. On three consecutive days, saliva cortisol levels were analyzed three times per day. Cognitive function was assessed on the day before and the day after surgery using comprehensive neuropsychological testing of multiple cognitive functions including memory, executive function, attention and processing speed.

Results Comparing the regional anesthesia group (RAG, n = 28) with the general anesthesia group (GAG, n = 18) no significant difference in the postoperative cognitive function was observed. However, patients in the GAG had significantly higher postoperative cortisol levels when compared to patients in the RAG. In both groups, a peak of cortisol value was detected on the day of surgery, which was higher in the GAG in comparison to the RAG.

Conclusions We did not observe a difference in postoperative cognitive function between patients undergoing regional or general anesthesia for dermatology surgery. However, we found lower cortisol level in the RAG. Based on these findings, future studies should investigate alternatives to reduce stress in a general anesthesia setting.