全身麻醉与非全身麻醉对患者术后认知功能障碍的系统评价  

Effect evaluation of general anesthesia and non-general anesthesia on postoperative cognitive dysfunction in patients: A systematic review

作　　者：何宇红[1] 王雅枫 刘雅静[2] 万杏[2] 黎梅[2] He Yuhong;Wang Yafeng;Liu Yajing;Wan Xing;Li Mei(Office of Infection Control,Peoples Hospital of Wuhan University,Wuhan Hubei 430060;Department of Anesthesiology,Peoples Hospital of Wuhan University,Wuhan Hubei 430060)

机构地区：[1]武汉大学人民医院院感办,湖北武汉430060 [2]武汉大学人民医院麻醉科,湖北武汉430060

出　　处：《护士进修杂志》2019年第21期1937-1941,共5页Journal of Nurses Training

摘　　要：目的系统评价全身麻醉与非全身麻醉对患者术后认知功能障碍(POCD)的效果。方法考克兰检索临床对照试验数据库(Cochrane central register of controlled trials)、PubMed、Medline、WOS核心合集等数据库中有关全身麻醉与非全身麻醉对患者POCD的临床、随机、对照研究,同时检索纳入研究的参考文献,检索时间均从建库至2017年9月。应用Cochrane协作网系统评价法对纳入文献进行评价和资料提取,评价指标为患者术后1 d、3 d、7 d、3个月的认知功能障碍。采用RevMan 5.2软件进行系统评价。结果纳入7项研究,共计1031例患者。Meta分析示:全身麻醉与非全身麻醉对患者术后1 d认知功能障碍的比较,差异有统计学意义[WMD=3.86,95%CI(1.18,12.58),P=0.03];全身麻醉与非全身麻醉对患者术后3 d认知功能障碍的比较,差异有统计学意义[WMD=2.00,95%CI(1.11,3.58),P=0.02];全身麻醉与非全身麻醉对患者术后7 d认知功能障碍的比较,差异无统计学意义[WMD=1.29,95%CI(0.84,1.98),P=0.25];全身麻醉与非全身麻醉对患者术后3个月认知功能障碍的比较,差异无统计学意义[WMD=0.57,95%CI(0.17,1.85),P=0.35]。结论现有研究显示术后3 d内,全身麻醉患者POCD发生率显著高于非全身麻醉患者,7 d后两者无显著差异,建议在术后3 d内对POCD高风险患者进行早期干预。Objective To systematic evaluate the effect of general anesthesia and non-general anesthesia on postoperative cognitive dysfunction(POCD)in patients.Methods Cochrane central register of controlled trials,PubMed,Medline,WOS and other databases were searched for the randomized controlled trials(RCTs)of general anesthesia and non-general anesthesia on postoperative cognitive dysfunction in patients from the date of establishment of the databases to Sep 2017.The bibliographies of the included studies were also searched.Researchers evaluated the included studies and analyzed by RevMan 5.2.Results A total 7 trials were discovered and included 1031 patients.Meta-analysis showed that there was significant difference postoperative cognitive dysfunction between general anesthesia and non-general anesthesia.The POCD in 1 d measured by FMA[WMD=3.86,95%CI(1.18,12.58),P=0.03];The POCD in 3 d measured by FMA[WMD=2.00,95%CI(1.11,3.58),P=0.02];the POCD in 7 d measured by FMA[WMD=1.29,95%CI(0.84,1.98),P=0.25];The POCD in 3 m measured by FMA[WMD=0.57,95%CI(0.17,1.85),P=0.35].Conclusion The current evidence shows the ratio of POCD in general anesthesia is higher than non-general anesthesia in 3 d after the surgery,however,after 7 d,there is no gignificant different between two groups.It is suggested that early intervention should be performed in 3 d after surgery on high-risk of POCD patients.

关 键 词：全身麻醉 术后认知功能障碍 非全身麻醉 系统评价 

分 类 号：R472.3[医药卫生—护理学]