区域麻醉或全身麻醉后的认知功能：人群研究
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Cognitive function after surgery with regional or general anesthesia: A population-based study
背景与目的
本研究旨在检测与早期报道的全身麻醉（GA）后相比较，区域麻醉（RA）下手术是否会加速长期认知能力下降。
方 法
我们对1819名老年人进行了纵向认知功能分析。模型评估了受试者施行RA或GA后的整体和特定领域的认知功能随时间的变化率。
结 果
与未麻醉组相比，同时施行RA(年递减率差为－0.041, P =0.011)和GA(年递减率差为－0.061, P ＜0.001)的患者术后认知整体z评分的变化率更大；但两者的变化率之间差异无显著性。对特定领域评分进行分析后发现，GA后记忆力加速下降(－0.065, P <.001)，而RA则没有(－0.011, P =0.565)。
结 论
区域麻醉下施行手术的老年患者整体认知能力会出现下降，这与全身麻醉相似；但区域麻醉老年患者记忆未受影响。
原始文献摘要
Sprung J, Schulte PJ, Knopman DS, et al. Cognitive function after surgery with regional or general anesthesia: A population-based study[J]. Alzheimers Dement, 2019,15(10):1243-1252.
Introduction: Our aim was to examine whether surgery with regional anesthesia (RA) is associated with accelerated long-term cognitive decline comparable with that previously reported after general anesthesia (GA).
Methods: Longitudinal cognitive function was analyzed in a cohort of 1819 older adults. Models assessed the rate of change in global and domain-specific cognition over time in participants exposed to RA or GA.
Results: When compared with those unexposed to anesthesia, the postoperative rate of change of the cognitive global z-score was greater in those exposed to both RA (difference in annual decline of －0.041, P = .011) and GA (－0.061, P ＜.001); these rates did not differ. In analysis of the domain-specific scores, an accelerated decline in memory was observed after GA (－0.065, P＜.001) but not RA (－0.011, P = .565).
Conclusions: Older adults undergoing surgery with RA experience decline of global cognition similar to those receiving GA; however, memory was not affected.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：唐剑 编辑：何幼芹 审校：王贵龙