作为区域麻醉和镇痛结果的术后认知功能。

Postoperative cognitive function as an outcome of regional anesthesia and analgesia.

作者信息

Wu Christopher L, Hsu Wesley, Richman Jeffrey M, Raja Srinivasa N

机构信息

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Carnegie 280, 600 North Wolfe Street, Baltimore, MD 21287, USA.

出版信息

Reg Anesth Pain Med. 2004 May-Jun;29(3):257-68. doi: 10.1016/j.rapm.2003.11.007.

DOI:10.1016/j.rapm.2003.11.007

PMID:15138912

Abstract

BACKGROUND AND OBJECTIVES

It has been suggested that intraoperative neuraxial (spinal, epidural) anesthesia may decrease postoperative cognitive dysfunction when compared with general anesthesia, but the issue remains controversial. We systematically reviewed the data from published studies to determine the effect of intraoperative neuraxial anesthesia versus general anesthesia on postoperative cognitive dysfunction and delirium.

METHODS

Studies were identified by searching the PubMed database of the National Library of Medicine (1966 to 2003) for terms related to cognitive dysfunction after surgery. Inclusion criteria were a comparison of intraoperative neuraxial anesthesia versus general anesthesia, and the outcome of postoperative cognitive dysfunction. A total of 196 abstracts were identified, and 24 articles were analyzed. Each article was reviewed, and data were extracted from tables or text or extrapolated from figures as needed.

RESULTS

Of the 24 trials obtained, 19 were randomized and 4 were observational (nonrandomized) trials (1 trial was a combination of randomized and observational data). The age of patients studied was typically greater than 60 years, and a wide range of neuropsychometric tests were used to evaluate cognitive function. The majority of trials (23/24 of all trials and 18/19 of randomized trials) did not demonstrate a benefit from neuraxial anesthesia in decreasing the incidence of postoperative cognitive dysfunction.

CONCLUSIONS

The use of intraoperative neuraxial anesthesia does not appear to decrease the incidence of postoperative cognitive dysfunction when compared with general anesthesia. There are methodologic and study-design issues present in many studies, and further elucidation of the pathophysiology of postoperative cognitive dysfunction may provide a direction for future studies.

摘要

背景与目的

有观点认为，与全身麻醉相比，术中神经轴索（脊髓、硬膜外）麻醉可能会降低术后认知功能障碍的发生率，但这一问题仍存在争议。我们系统回顾了已发表研究的数据，以确定术中神经轴索麻醉与全身麻醉对术后认知功能障碍和谵妄的影响。

方法

通过检索美国国立医学图书馆的PubMed数据库（1966年至2003年），查找与术后认知功能障碍相关的术语来确定研究。纳入标准为术中神经轴索麻醉与全身麻醉的比较，以及术后认知功能障碍的结果。共识别出196篇摘要，并分析了24篇文章。对每篇文章进行了回顾，并根据需要从表格、文本中提取数据或从图表中推断数据。