【罂粟摘要】不同麻醉方式对老年患者术后认知功能及其应激反应的影响：一项单中心观察性研究

不同麻醉方式对老年患者术后认知功能及其应激反应的影响：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：安丽 

编辑：宋雨婷

审校：曹莹

1背景

随着年龄的增长，老年患者在手术后认知能力下降的风险更高，即使是为老年患者制定了周密的麻醉方案，术后认知功能障碍的风险仍然很高。患者来自焦虑和麻醉本身的额外压力会对其术后认知功能产生负面影响。本研究的目的是评估全身麻醉与区域麻醉对老年患者术后认知功能和围术期应激指标的影响。

2方法

在这项单中心前瞻性研究中，纳入了在2014年12月至2015年11月收治的46名50至85岁的皮肤科手术患者。患者被分为全身麻醉组和区域麻醉组。连续三天，每天分析三次唾液皮质醇水平。在手术前一天和手术后一天使用综合多种认知功能的神经心理学测试进行评估，包括记忆力、执行力、注意力和应变速度。

3结果

将区域麻醉组(RAG,n=28)与全身麻醉组(GAG,n=18)进行比较，未观察到术后认知功能存在显著差异。然而，与RAG患者相比，GAG患者的术后皮质醇水平明显更高。在两组中，在手术当天检测到皮质醇值的峰值，与RAG相比，GAG中的皮质醇值更高。

4结论

在接受区域麻醉或全身麻醉的皮肤科手术患者中，我们没有观察到术后认知功能的差异。然而，我们发现RAG中的皮质醇水平较低。基于这些发现，未来的研究应探讨在全身麻醉下减少应激反应的替代方案。

原始文献来源：

Soeren Wagner, Martin Breitkopf, Elena Ahrens, Haobo Ma, Olivia Kuester, Christine Thomas, Christine A. F. von Arnim and Andreas Walther.Cognitive function in older patients and their stress challenge using diferent anesthesia regimes:a single center observational study.Wagner et al. BMC Anesthesiology (2023) 23:6.Doi.org/10.1186/s12871-022-01960-7  

英文原文

Cognitive function in older patients and their stress challenge using diferent anesthesia regimes:

 a single center observational study

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 stratifed 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 signifcant diference in the postoperative cognitive function was observed. However, patients in the GAG had signifcantly 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 diference 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 fndings, future studies should investigate alternatives to reduce stress in a general anesthesia setting.

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