【罂粟摘要】静脉麻醉与吸入性麻醉对老年腹腔镜腹部手术患者术后认知的影响：一项多中心、随机试验
静脉麻醉与吸入性麻醉对老年腹腔镜腹部手术患者术后认知的影响：一项多中心、随机试验
贵州医科大学 高鸿教授课题组
翻译：佟睿 编辑：佟睿 审校：曹莹
手术后神经认知功能恢复延迟与预后不良有关。大多数手术都需要全身麻醉，其中七氟醚和丙泊酚是最常用的吸入和静脉麻醉剂。作者验证了最初的假设，即在丙泊酚麻醉下进行腹腔镜腹部手术的患者比在七氟醚麻醉下进行腹腔镜手术的患者神经认知恢复延迟的发生率更低。第二个假设是，存在某种血液生物标志物可以预测神经认知恢复延迟的发生。
在中国的四家医院进行了一项随机、双盲、平行、对照研究。接受腹腔镜腹部手术时间可能超过2小时的老年(60岁及以上)患者被随机分成丙泊酚或七氟醚作为基础药物方案维持全身麻醉，每组至少分配221名患者进行验证。与七氟醚组相比，丙泊酚组延迟神经认知恢复的发生率降低了三分之一。主要观察指标是术后5-7天神经认知功能恢复延迟情况。
共纳入544名患者，每组272名患者。其中对丙泊酚组226例和七氟醚组221例患者完成了神经认知恢复延迟的神经心理学检查，七氟醚组中的46例(20.8%)和丙泊酚组中的38例(16.8%)符合神经认知恢复延迟的标准(优势比0.77；95%CI：0.48~1.24；P=0.279)。切皮后1h血白细胞介素-6浓度升高与神经认知功能恢复延迟的可能性增加(优势比1.04；95%CI：1.01~1.07；P=0.007)。两组不良事件发生率相近。
腹腔镜腹部手术后5至7天，在丙泊酚和七氟醚之间的麻醉选择似乎不会影响神经认知恢复延迟的发生率。手术切皮后血中白细胞介素-6浓度升高可能是神经认知功能恢复延迟的独立危险因素。
Intravenous versus Volatile Anesthetic Effects on Postoperative Cognition in Elderly Patients Undergoing Laparoscopic Abdominal Surgery: A Multicenter, Randomized Trial
Background: Delayed neurocognitive recovery after surgery is associated with poor outcome. Most surgeries require general anesthesia, of which sevoflurane and propofol are the most commonly used inhalational and intravenous anesthetics. The authors tested the primary hypothesis that patients with laparoscopic abdominal surgery under propofol-based anesthesia have a lower incidence of delayed neurocognitive recovery than patients under sevoflurane-based anesthesia. A second hypothesis is that there were blood biomarkers for predicting delayed neurocognitive recovery to occur.
Methods: A randomized, double-blind, parallel, controlled study was performed at four hospitals in China. Elderly patients (60 yr and older) undergoing laparoscopic abdominal surgery that was likely longer than 2 h were randomized to a propofol- or sevoflurane-based regimen to maintain general anesthesia. A minimum of 221 patients was planned for each group to detect a one-third decrease in delayed neurocognitive recovery incidence in propofol group compared with sevoflurane group. The primary outcome was delayed neurocognitive recovery incidence 5 to 7 days after surgery.
Results: A total of 544 patients were enrolled, with 272 patients in each group. Of these patients, 226 in the propofol group and 221 in the sevoflurane group completed the needed neuropsychological tests for diagnosing delayed neurocognitive recovery, and 46 (20.8%) in the sevoflurane group and 38 (16.8%) in the propofol group met the criteria for delayed neurocognitive recovery (odds ratio, 0.77; 95% CI, 0.48 to 1.24; P = 0.279). A high blood interleukin-6 concentration at 1 h after skin incision was associated with an increased likelihood of delayed neurocognitive recovery (odds ratio, 1.04; 95% CI, 1.01 to 1.07; P = 0.007). Adverse event incidences were similar in both groups.
Conclusions: Anesthetic choice between propofol and sevoflurane did not appear to affect the incidence of delayed neurocognitive recovery 5 to 7 days after laparoscopic abdominal surgery. A high blood interleukin-6 concentration after surgical incision may be an independent risk factor for delayed neurocognitive recovery.