七氟烷、丙泊酚与老年肺癌手术患者术后早期认知功能障碍关系的Meta分析

The Relationship between Propofol,Sevoflurane and Early Cognitive Dysfunction in Elderly Patients Undergone Lung Cancer Surgery: A Meta-Analysis

目的:系统评价丙泊酚与七氟烷对老年肺癌患者术后早期认知功能的影响。方法:计算机检索Cochrane Library、Pubmed、Web of Science、中国知网、维普智立方、万方数据知识服务平台中关于丙泊酚、七氟烷全身麻醉老年肺癌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2019年3月。由研究者根据Cochrane系统评价的方法评价纳入研究的质量和提取资料,采用Rev Man 5.3软件进行统计学分析。结果:共纳入9个RCT,老年肺癌患者915例。术前两组患者基本情况相同,简易智能状态量表(minimental state examination,MMSE)评分和S100β蛋白浓度差异无统计学意义。术后6 h,1 d,3 d,7 d两组MMSE评分均降低,七氟烷组高于丙泊酚组,且术后1、3、7 d时两组MMSE评分差异有统计学意义(P<0.05)。术后10 min,30 min,1 d七氟烷组和丙泊酚组S100β蛋白浓度均增高,七氟烷组低于丙泊酚,且术后1 d时两组差异具有统计学意义(P<0.05)。结论:对于行肺癌手术的老年患者,七氟烷和丙泊酚均可能导致术后早期认知功能障碍,但七氟烷相较于丙泊酚,术后早期认知功能障碍发生率较低,是一个更好的选择。

Objective To systematically evaluate the influence of propofol and sevoflurane on early cognitive function in elderly patients with lung cancer after surgery. Methods A randomized controlled trial of early postoperative cognitive dysfunction in elderly patients with lung cancer who were treated with propofol and sevoflurane in patients with Cochrane Library,Pubmed,Web of Science,China Knowledge Network,Weipuzhi Cube,and Wanfang Data Knowledge Service Platform Test( RCT). The search time limit is built until March 2019. The quality and extracted data of the included studies were evaluated by the investigators according to the method of the Cochrane systematic review,and statistical analysis was performed using Rev Man 5.3 software. Results A total of 9 RCTs were included and 915 elderly patients with lung cancer were enrolled. Before operation,the two groups had the same basic condition. There was no significant difference in the scores of mini-mental state examination( MMSE) and the concentration of S100 beta protein between the two groups. The MMSE scores of the two groups decreased 6 h,1 d,3 d and 7 d after operation. The MMSE scores of the sevoflurane group were higher than those of the propofol group,and there was significant difference between the two groups at 1,3 and 7 days after operation( P<0.05). The concentration of S100 beta protein in sevoflurane group and propofol group increased 10 min,30 min,and 1 day after operation. The concentration of S100 beta protein in sevoflurane group was lower than that in propofol group,and there was significant difference between the two groups at 1 day after operation( P< 0.05). Conclusion Both propofol and sevoflurane may lead to early postoperative cognitive dysfunction( POCD) in elderly patients undergoing lung cancer surgery,but sevoflurane is a better choice than propofol because of its lower incidence of early postoperative cognitive dysfunction.