Aiello Bowles Erin J, Larson Eric B, Pong Ryan P, Walker Rod L, Anderson Melissa L, Yu Onchee, Gray Shelly L, Crane Paul K, Dublin Sascha
Group Health Research Institute, Group Health Cooperative, Seattle, Washington.
Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington.
J Am Geriatr Soc. 2016 Mar;64(3):602-7. doi: 10.1111/jgs.14024. Epub 2016 Feb 11.
To evaluate the associations between anesthesia and dementia or Alzheimer's disease (AD) risk using prospectively collected data.
Cohort study.
Community-dwelling members of the Adult Changes in Thought cohort aged 65 and older and free of dementia at baseline (N = 3,988).
Participants self-reported all prior surgical procedures with general or neuraxial (spinal or epidural) anesthesia at baseline and reported new procedures every 2 years. People undergoing high-risk surgery with general anesthesia, other surgery with general anesthesia, and other surgery with neuraxial anesthesia exposures were compared with those with no surgery and no anesthesia. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for dementia and AD associated with time-varying lifetime and recent (past 5 years) anesthesia exposures.
At baseline, 254 (6%) people reported never having anesthesia; 248 (6%) had had one or more high-risk surgeries with general anesthesia, 3,363 (84%) had had one or more other surgeries with general anesthesia, and 123 (3%) had had one or more surgeries with neuraxial anesthesia. High-risk surgery with general anesthesia was not associated with greater risk of dementia (HR = 0.86, 95% CI = 0.58-1.28) or AD (HR = 0.95, 95% CI = 0.61-1.49) than no history of anesthesia. People with any history of other surgery with general anesthesia had a lower risk of dementia (HR = 0.63, 95% CI = 0.46-0.85) and AD (HR = 0.65, 95% CI = 0.46-0.93) than people with no history of anesthesia. There was no association between recent anesthesia exposure and dementia or AD.
Anesthesia exposure was not associated with of dementia or AD in older adults.
使用前瞻性收集的数据评估麻醉与痴呆症或阿尔茨海默病（AD）风险之间的关联。
队列研究。
成人思维变化队列中65岁及以上的社区居住成员，基线时无痴呆症（N = 3988）。
参与者在基线时自我报告所有先前接受全身或神经轴（脊髓或硬膜外）麻醉的外科手术，并每2年报告新的手术。将接受全身麻醉的高风险手术、其他全身麻醉手术和其他神经轴麻醉手术的人与未进行手术和未接受麻醉的人进行比较。使用Cox比例风险模型估计与随时间变化的终生和近期（过去5年）麻醉暴露相关的痴呆症和AD的风险比（HR）和95%置信区间（CI）。
在基线时，254人（6%）报告从未接受过麻醉；248人（6%）接受过一次或多次全身麻醉的高风险手术，3363人（84%）接受过一次或多次其他全身麻醉手术，123人（3%）接受过一次或多次神经轴麻醉手术。与无麻醉史相比，全身麻醉的高风险手术与痴呆症（HR = 0.86，95%CI = 0.58 - 1.28）或AD（HR = 0.95，95%CI = 0.61 - 1.49）风险增加无关。有任何其他全身麻醉手术史的人比无麻醉史的人患痴呆症（HR = 0.63，95%CI = 0.46 - 0.85）和AD（HR = 0.65，95%CI = 0.46 - 0.93）的风险更低。近期麻醉暴露与痴呆症或AD之间无关联。
麻醉暴露与老年人的痴呆症或AD无关。
