麻醉深度影响非心脏手术患者全身麻醉手术后认知功能障碍发生的Meta分析  

Effect of depth of anesthesia on postoperative cognitive dysfunction in noncardiac surgical patients： a Meta analysis ofrandomized controlled trials

作　　者：安然[1] 庞倩芸[1] 刘红亮[1] 

机构地区：[1]重庆市肿瘤研究所、医院、癌症中心手术麻醉科,400030

出　　处：《国际麻醉学与复苏杂志》2017年第4期315-322,337,共9页International Journal of Anesthesiology and Resuscitation

摘　　要：目的分析麻醉深度对非心脏手术患者全身麻醉手术后近期及远期认知功能障碍发生和血清smog蛋白水平的影响。方法检索PubMed、The Cochrane Library、EBSCO、Springer、Ovid、中国生物医学文献服务系统、中国知网、万方数据库、维普网，检索时间为建库至2016年2月。共检索到352篇有关麻醉深度对术后认知功能障碍（postoperative cognitive dysfunction，POCD）及血清sloot3蛋白影响的文献，共纳入20篇随机对照试验（randomized controlled trials，RCT），采用RevMan5．3软件进行分析。结果共有2665例患者纳入研究，Meta分析显示：深麻醉手术后1d[比值比（oddsratio,OR）=O．3l，95％CI：0．24-0．40]、术后3-5d（OR=O．35，95％CI：0．24加．51）、术后7d（OR=0，45，95％C／：0．27-0．74）、术后1。3个月内（OR：O．66，95％CI：0．45-0．99）POCD发生率及手术后1d血清sloola蛋白[均数差（meandeviation，MD）=-270．29，95％CI：-295．81～-244．77]低于浅麻醉组（P〈0．05）。结论深麻醉可显著降低术后7d内及术后1-3个月内POCD发生率，并降低血清中术后1d S100β蛋白水平：血清S100β蛋白水平可能与POCD发牛率有关。Objective Summarizing the related published articles about depth of anesthesia and postoperative cognitive dysfunction （POCD） in noncardiac surgical patients, and observing the effect of depth of anesthesia on short-term or long-term POCD. Methods The literature searching indentified 352 articles related to the topic from PubMed, The Cochrane Library, EBSCO, Springer, Ovid, National Knowledge Infrastructure （CNKI）, Wanfang data library and VIP network （by February 2016）.＇ As our aim tended to focus on the effect of depth of anesthesia on POCD and S10013 protein level, twenty randomized controlled trials were finally included and the Meta analysis was performed using RevMan 5.3 software. Results A total of 2665 patients from 20 randomized controlled trials （RCT） was enrolled. The Meta analysis showed that, deep anesthesia decreased POCD incidence significantly compared with light anesthesia postoperative day l[odds ratio（OR）=0.31, 95%CI： 0.24-0.40], from day 3 to 5（OR=0.35, 95%CI： 0.24- 0.51）, day 7 （OR=0.45, 95%CI： 0.27-0.74）, or within the 1st to 3rd month（OR=0.66, 95%CI： 0.45-0.99） after surgery. S10013 protein level in patients receiving deep anesthesia was much lower than that in patients receiving light anesthesia[mean deviation（MD）=-270.29, 95%CI： -295.81- -244.77] on postoperative day 1. Conclusions Deep anesthesia can significantly reduce the incidence of POCD within postoperative 7th day, 1st to 3rd month after surgery. Serum S10013 protein level which may be closely related to POCD incidence could be reduced by deep anesthesia on postoperative day 1.

关 键 词：麻醉深度 术后认知功能障碍 Sl00β蛋白 META分析 

分 类 号：R614[医药卫生—麻醉学]