老年髋部骨折手术患者区域麻醉与全身麻醉后12个月术后认知功能下降的发生率：RAGA试验的随访
Incidence of 12-month postoperative cognitive decline following regional vs. general anaesthesia in older patients undergoing hip fracture surgery: follow-up of the RAGA trial.
作者信息
Li Ting, Li Jun, Jiang Chenchen, Yuan Liyong, Wu Jinze, Mazaheri Ali, Wang Mingcang, Jin Shengwei, Myles Paul S, Yao Yinguang, Wu Jimin, Chen Junping, Smith Fang G
机构信息
Department of Anaesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
Clinical Research Unit, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
出版信息
Anaesthesia. 2025 Jul;80(7):771-780. doi: 10.1111/anae.16545. Epub 2025 Jan 23.
INTRODUCTION
Data regarding the incidence of 12-month postoperative cognitive decline following regional or general anaesthesia in older patients undergoing hip fracture surgery remain observational. Compared with general anaesthesia, we hypothesised that regional anaesthesia would decrease the incidence of 12-month postoperative cognitive decline.
METHODS
This is substudy of a multicentre randomised trial of regional anaesthesia with no sedation vs. general anaesthesia with 12-month follow-up, conducted in nine university hospitals in south-eastern China. Patients aged ≥ 65 y with hip fractures requiring surgery were eligible for inclusion. The prespecified 1-year primary outcome was the incidence of postoperative cognitive decline at 12 months post-randomisation. Secondary outcomes included major or mild postoperative cognitive decline; changes in Mini-Mental State Examination; newly developed dementia; affective status; and health-related quality of life.
RESULTS
We recruited 950 patients between October 2014 and September 2018 (n = 474 general and n = 476 regional), with the last participant interviewed in November 2019. A total of 293 patients (139 general vs. 154 regional) were included in the primary analysis of the 12-month outcome. Median (IQR [range]) age of patients was 78 (71-82 [65-96]) y and 217 (74.1%) were female. The incidence of cognitive decline at 12 months was 29.7% vs. 25.4% of patients allocated to general vs. regional anaesthesia, respectively (unadjusted OR 1.2 (95%CI 0.7-2.1), p = 0.43, Bayes factor = 0.28). Major cognitive decline developed in 8.6% vs. 8.5% of patients allocated to general vs. regional anaesthesia, respectively (unadjusted OR 1.0 (95%CI 0.4-2.4)).
DISCUSSION
The incidence of 12-month postoperative cognitive decline was not significantly different in patients having general or regional anaesthesia for hip fracture surgery.
引言
关于老年髋部骨折手术患者区域麻醉或全身麻醉后12个月认知功能下降发生率的数据仍为观察性数据。与全身麻醉相比，我们假设区域麻醉会降低12个月术后认知功能下降的发生率。
方法
这是一项在中国东南部9家大学医院进行的多中心随机试验的子研究，比较无镇静的区域麻醉与全身麻醉，并进行12个月的随访。年龄≥65岁且需要手术治疗髋部骨折的患者符合纳入标准。预先设定的1年主要结局是随机分组后12个月时术后认知功能下降的发生率。次要结局包括严重或轻度术后认知功能下降；简易精神状态检查的变化；新发痴呆；情感状态；以及健康相关生活质量。
结果
我们在2014年10月至2018年9月期间招募了950例患者（全身麻醉组474例，区域麻醉组476例），最后一名参与者于2019年11月接受访谈。共有293例患者（全身麻醉组139例，区域麻醉组154例）纳入12个月结局的主要分析。患者的年龄中位数（IQR[范围]）为78（71 - 82[65 - 96]）岁，女性患者有217例（74.1%）。分配至全身麻醉组和区域麻醉组的患者在12个月时认知功能下降的发生率分别为29.7%和25.4%（未调整的OR为1.2（95%CI 0.7 - 2.1），p = 0.43，贝叶斯因子 = 0.28）。分配至全身麻醉组和区域麻醉组的患者分别有8.6%和8.5%发生严重认知功能下降（未调整的OR为1.0（95%CI 0.4 - 2.4））。
讨论
接受髋部骨折手术的患者在全身麻醉或区域麻醉后12个月认知功能下降的发生率无显著差异。
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