与七氟醚全身麻醉相比，丙泊酚可降低老年人神经认知功能恢复延迟的发生率
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Propofol compared with sevoflurane general anaesthesia is associated with decreased delayed neurocognitive recovery in older adults
背景与目的：全身麻醉药的选择可能会影响术后认知结局。本研究旨在比较基于丙泊酚和基于七氟醚的全身麻醉对重大癌症手术后老年人早期神经认知功能恢复延迟的潜在影响。
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方法：纳入计划接受重大癌症手术（约2小时）的老年人（年龄≥65岁和<90岁）随机接受丙泊酚或七氟醚为基础的全身麻醉。通过一系列神经心理学测试评估术前和术后1周的认知功能。纳入年龄和教育相当的非手术老年人为对照组，并以相同的时间间隔测试他们的认知功能，通过重复测试以调整学习的影响。根据国际术后认知功能障碍1定义诊断神经认知功能恢复延迟。
结果：共纳入2015年4月1日至2016年10月15日期间392名患者并对其随机分组。在这些患者中，我们对387人进行了干预和30天的随访，379人完成了1周后的神经心理学测试。纳入了59名对照受试者并完成了重复的神经心理学测试。丙泊酚组[14.8％（28/189）] 1周后神经认知功能恢复延迟的发生率显着著低于七氟醚组[23.2％（44/190）;比值比= 0.577; 95％置信区间，0.342e0.975;P¼0.038。两组的安全性结局没有差异。
结论与讨论：与基于七氟醚的全身麻醉比较，基于丙泊酚的全身麻醉可降低老年人在重大癌症手术后神经认知功能恢复延迟的发生率。
Zhang Y1, Shan GJ1, Zhang YX1, Cao SJ1, Zhu SN2, Li HJ3, Ma D4, Wang DX5;
Propofol compared with sevoflurane general anaesthesia is associated with decreased delayed neurocognitive recovery in older adults
Br J Anaesth. 2018 Sep;121(3):595-604. doi: 10.1016/j.bja.2018.05.059. Epub 2018 Jul 27.
BACKGROUND:
Abstract
Background: The choice of general anaesthetics may affect postoperative cognitive outcomes. This study was designed to compare the potential impact of propofol-based vs sevoflurane-based general anaesthesia on the development of delayed neurocognitive recovery in older adults early after major cancer surgery.
Methods: Older adults (aged 65 and <90 yr) who were scheduled to undergo major cancer surgery (2 h) were randomised to receive either propofol- or sevoflurane-based general anaesthesia. Cognitive function was assessed before and 1 week after surgery with a battery of neuropsychological tests. Age- and education-matched non-surgical controls were recruited, and their cognitive functions were tested at comparable time intervals in order to adjust for learning effects
from repeated tests. Delayed neurocognitive recovery was diagnosed according to the International Study of Postoperative Cognitive Dysfunction 1 definition.
Results: From April 1, 2015 to October 15, 2016, 392 patients were enrolled and randomised. Of these patients, 387 completed the intervention and 30-day follow-up, and 379 completed 1-week neuropsychological tests. Fifty-nine control subjects were enrolled and completed repeated neuropsychological tests. The incidence of delayed neurocognitive recovery at 1 week was significantly lower in the propofol group [14.8% (28/189)] than in the sevoflurane group [23.2% (44/190);
odds ratio¼0.577; 95% confidence interval, 0.342e0.975; P¼0.038]. Safety outcomes did not differ between the two groups.
Conclusions: When compared with sevoflurane-based general anaesthesia, propofol-based general anaesthesia might decrease the incidence of delayed neurocognitive recovery in older adults after major cancer surgery.
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