异氟醚和地氟醚用于老年患者术后认知功能下降的比较评估：前瞻性观察性初步研究。

Comparative evaluation of isoflurane and desflurane for postoperative cognitive decline in elderly patients: A prospective observational pilot study.

机构信息

Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India.

Department of Anaesthesiology, All India Institute of Medical Sciences, Kalyani, India.

出版信息

J Perioper Pract. 2024 Jun;34(6):187-194. doi: 10.1177/17504589231180737. Epub 2023 Aug 30.

DOI:10.1177/17504589231180737

PMID:37646417

Abstract

BACKGROUND

Approximately 16%-62% of patients undergoing non cardiac surgeries develop postoperative cognitive dysfunction. We compared the incidence of postoperative cognitive dysfunction in older adults aged 60-80 years who underwent open abdominal surgeries under general anaesthesia using isoflurane or desflurane and correlated it with the serum concentration of interleukin 1, interleukin 6, tumour necrosis factor alpha, amyloid β and S100 on postoperative day 3.

METHOD

Forty American Association of Anesthesiologists Physical Classification I or II patients were included after acquiring institutional ethics committee approval, registering in the Clinical Trials Registry - India, and informed written consent. They underwent open abdominal surgery under general anaesthesia and epidurals between 2017 and 2019. Patients with substance abuse or any disorder affecting cognition were excluded. Postoperative cognitive dysfunction was assessed by Stroop test, Wisconsin Card Sorting Test, Trail making test - B, Porteus Maze test, PGI memory scale, mini-mental state examination, and Bender Gestalt test the day before surgery and on the third postoperative day along with blood samples.

RESULTS

Thirty-seven percent of the patients developed postoperative cognitive dysfunction. The risk was similar to isoflurane in comparison with desflurane (risk ratio: 0.65, 95% confidence interval: 0.30, 1.40). A significant percentage increase in reaction time for Porteus Maze test and Trail making test - B was noted with isoflurane (6.69 (4.20-8.94) and 8.01 (2.08-12.5), respectively) in comparison with desflurane group (13.01 (9.09-17.33), p = 0.003 and 11.62 (7.5-17.5), p = 0.017, respectively).

CONCLUSION

Isoflurane and desflurane had a similar impact on the elderly for developing postoperative cognitive dysfunction and no correlation with any of the biomarkers used in the study on postoperative day 3.

摘要

背景

大约 16%-62%接受非心脏手术的患者会出现术后认知功能障碍。我们比较了在全身麻醉下使用异氟醚或地氟醚进行开放性腹部手术的 60-80 岁老年患者术后认知功能障碍的发生率，并将其与术后第 3 天的白细胞介素 1、白细胞介素 6、肿瘤坏死因子 α、淀粉样 β 和 S100 血清浓度相关联。

方法

在获得机构伦理委员会批准、在印度临床试验注册处注册并获得书面知情同意后，纳入 40 名美国麻醉医师协会身体状况分类 I 或 II 级患者。他们在 2017 年至 2019 年期间接受全身麻醉和硬膜外麻醉下的开放性腹部手术。排除有物质滥用或任何影响认知的疾病的患者。在手术前一天和术后第 3 天，通过 Stroop 测试、威斯康星卡片分类测试、Trail 制作测试 B、Porteus 迷宫测试、PGI 记忆量表、简易精神状态检查和 Bender Gestalt 测试评估术后认知功能障碍，并采集血样。

结果

37%的患者出现术后认知功能障碍。与地氟醚相比，异氟醚的风险相似（风险比：0.65，95%置信区间：0.30，1.40）。与地氟醚组相比，异氟醚组的 Porteus 迷宫测试和 Trail 制作测试 B 的反应时间显著增加（分别为 6.69（4.20-8.94）和 8.01（2.08-12.5））（分别为 13.01（9.09-17.33），p=0.003 和 11.62（7.5-17.5），p=0.017）。