Department of Anesthesiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC.
Graduate Institute of Biomedical Electronics and Bioinformatics, College of Electrical Engineering & Computer Science, National Taiwan University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2020 Apr;83(4):394-399. doi: 10.1097/JCMA.0000000000000286.
Anesthesia and surgery may increase the risk of dementia in the elderly, but the higher prevalence of dementia in women and other evidence suggest that dementia risk increases in younger women undergoing hysterectomy. In this study, we assessed the risk of dementia after hysterectomy.
Hysterectomies registered in the National Health Insurance Research Database from 2000 to 2013 were evaluated using a retrospective generational research method. Multivariate Cox regression analysis was used to assess the effect of age at surgery, anesthesia method, and surgery type on the hazard ratio (HR) for the development of dementia.
Among 280 308 patients who underwent hysterectomy, 4753 (1.7%) developed dementia. Age at surgery and anesthesia method were associated with the occurrence of dementia, independent of surgery type. Among patients 30-49 years of age, general anesthesia (GA) was associated with a higher risk of dementia than spinal anesthesia (SA). The HR for GA was 2.678 (95% confidence interval [CI] = 1.269-5.650) and the risk of dementia increased by 7.4% for every 1-year increase in age (HR = 1.074; 95% CI = 1.048-1.101). In patients >50 years of age, the HR for GA was 1.206 (95% CI = 1.057-1.376), and the risk of dementia increased by 13.0% for every 1-year increase in age (HR = 1.130; 95% CI = 1.126-1.134).
The risk of dementia in women who underwent hysterectomy was significantly affected by older age at surgery, and the risk might not increase linearly with age, but show instead an S-curve with exponential increase at about 50 years of age. Although less significant, GA was associated with higher risk than SA, and the effect of the anesthesia method was greater in patients <50 years of age. In contrast, the surgical procedure used was not associated to the risk of dementia.
麻醉和手术可能会增加老年人患痴呆症的风险，但痴呆症在女性中的更高患病率以及其他证据表明，接受子宫切除术的年轻女性痴呆症风险增加。在这项研究中，我们评估了子宫切除术后痴呆症的风险。
使用回顾性世代研究方法，评估了 2000 年至 2013 年在国家健康保险研究数据库中登记的子宫切除术。使用多变量 Cox 回归分析评估了手术时的年龄、麻醉方法和手术类型对痴呆发展的危险比（HR）的影响。
在接受子宫切除术的 280308 名患者中，有 4753 名（1.7%）发生了痴呆症。手术时的年龄和麻醉方法与痴呆症的发生有关，与手术类型无关。在 30-49 岁的患者中，全身麻醉（GA）与脊髓麻醉（SA）相比，痴呆症的风险更高。GA 的 HR 为 2.678（95%置信区间[CI] = 1.269-5.650），年龄每增加 1 岁，痴呆症的风险增加 7.4%（HR = 1.074；95% CI = 1.048-1.101）。在>50 岁的患者中，GA 的 HR 为 1.206（95%CI = 1.057-1.376），年龄每增加 1 岁，痴呆症的风险增加 13.0%（HR = 1.130；95%CI = 1.126-1.134）。
接受子宫切除术的女性患痴呆症的风险受手术时年龄的显著影响，且风险可能不会随年龄呈线性增加，而是呈 S 形曲线增加，约在 50 岁左右呈指数增加。虽然不太显著，但 GA 与 SA 相比风险更高，且麻醉方法的影响在<50 岁的患者中更大。相比之下，手术方式与痴呆症的风险无关。
