丙泊酚、七氟烷与老年患者非心脏手术术后认知功能障碍关系的Meta分析

The Relationship between Propofol,Sevoflurane and Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Non-cardiac Surgery: A Meta-Analysis

目的系统评价丙泊酚与七氟烷对老年非心脏手术患者术后早期认知功能的影响。方法计算机检索Cochrane library、Pubmed、MEDLINE、Embase、中国生物医学文献数据库、中国知网、维普数据库、万方数据库中关于丙泊酚与七氟烷全身麻醉老年非心脏手术患者术后早期发生认知功能障碍的随机对照试验(RCT),检索时限均为建库至2013年8月。由3名独立研究者严格按照标准进行相关资料提取与分析。采用Rev Man 5.1软件进行统计学分析。结果共纳入14个RCT,老年非心脏手术患者790例。术前两组患者基本情况相同,术后丙泊酚组患者睁眼、拔管时间短于七氟烷组;术后1 h、3 h、6 h简易智力状况检查法评分降低,术后3 d评分逐步恢复,且丙泊酚组皆高于七氟烷组,标准化均数差(95%CI)分别为-0.02(-0.19~0.13)、-0.77(-1.00^-0.54)、-0.85(-1.09^-0.62)、0.84(0.61~1.08)、1.12(0.86~1.38)、0.61(0.40~0.82)、-0.32(-0.56^-0.07);术后1 d、7 d丙泊酚组与七氟烷组评分差异无统计学意义(P>0.05)。术后24 h,丙泊酚组患者术后认知功能障碍患病率明显高于七氟烷组(P<0.05)。结论丙泊酚麻醉前者苏醒较快,拔管时间短,两种麻醉药均会引起老年非心脏手术患者早期认知功能降低,而丙泊酚作用弱于七氟烷。

Objective Tc systematically review the influence of propofol and sevoflurane on postopera- tive cognitive function in elderly patients shortly after non-cardiac surgery. Methods The databases of Coehrane library, Pubmed, MEDLINE, Embase, CBM, CNKI, VIP, Wan.fang were retrieved with computer for collecting randomized controlled trials （RCT） about the influence of pmpofol and sevoflurane on postoperative cognitive dysfunction in elderly patients shortly after non-cardiac surgery from the time of database establish- ment to August 2013. The reference materials were included selected, extracted and analyzed by three inde- pendent reviewers according to strict inclusion and exclusion criterions. RevMan 5. 1 was used for the data analysis. Results A total of 14 trials involving 790 elderly patients undergoing non-cardiac surgery were included. Preoperative conditions of two groups were basically same, while the eye opening time and extuba= tion time of propofal group were significantly shorter than sevonurane group ~ the postoperative 1 h, 3 h and 6 h mini-mental state examination scores of pmpofol group were obviously higher than the sevoflurane group. 3 d after the operation,the values returned to normal levels and the pmpofol group was still higher than the sevoflurane group, standardized mean difference （95% CI） ： - 0. 02 （ - 0. 19-0. 13 ） , - 0. 77 （ - 1.00- -0. 54） , -0.85（ - 1.09- - 0. 62） ,0. 84 （0. 61-1. 08 ）, 1.12 （0. 86-1.38 ） ,0. 61 （0.40-0. 82） , - 0. 32 （ -0. 56- 0. 07） ,the postoperative 1 d and 7 d difference between the two groups was not signifieant（P 〉 0. 05 ）. The incidence of early postoperative cognitive dysfunction of the propofol group was significantly higher than the sevoflurane group （ P 〈 0. 05 ）. Coneluslon Prepofol anesthesia has shorter recovery time and extubation time than sevoflurane, and both may lead to postoperative cognitive dysfunction POCD in eld- erly natlents early after non-cardiac surgery, and nronofol is a better choice for the elderly patients.