术后认知功能障碍(POCD)越来越被认为是术后并发症的原因。一个共识工作组建议将POCD区分为认知恢复延迟,ie,术后30天进行评估,和神经认知障碍,ie,在手术后30天至12个月之间进行评估。此外,麻醉剂的选择,吸入或全静脉麻醉(TIVA)及其对POCD发生率的影响,已成为研究的重点。我们的主要目的是搜索文献并进行荟萃分析,以验证全身麻醉的选择是否会影响术后前30天POCD的发生率。作为次要目标,我们对文献进行了系统回顾,以评估麻醉对术后30天至12个月POCD的影响.对于主要目标,对1913篇文章的初步审查产生了10项研究,共3390人.对于次要目标,共纳入4项研究,共480例患者.术后前30天,TIVA组POCD的比值比为0.46(95%CI=0.26-0.81;p=0.01),与吸入组相比。术后前30天TIVA与POCD发生率较低相关。关于次要目标,由于精选文章数量少,异质性高,没有进行元分析。鉴于POCD标准的异质性,未来应进行更稳健设计的前瞻性研究,以充分解决这一问题.
Postoperative cognitive dysfunction (
POCD) has been increasingly recognized as a contributor to postoperative complications. A consensus-working group recommended that POCD should be distinguished between delayed cognitive recovery, ie, evaluations up to 30 days postoperative, and neurocognitive disorder, ie, assessments performed between 30 days and 12 months after surgery. Additionally, the choice of the anesthetic, either inhalational or total intravenous anesthesia (TIVA) and its effect on the incidence of POCD, has become a focus of research. Our primary objective was to search the literature and conduct a meta-analysis to verify whether the choice of general anesthesia may impact the incidence of POCD in the first 30 days postoperatively. As a secondary objective, a systematic
review of the literature was conducted to estimate the effects of the anesthetic on
POCD between 30 days and 12 months postoperative. For the primary objective, an initial
review of 1913 articles yielded ten studies with a total of 3390 individuals. For the secondary objective, four studies with a total of 480 patients were selected. In the first 30 days postoperative, the odds-ratio for POCD in TIVA group was 0.46 (95% CI = 0.26-0.81; p = 0.01), compared to the inhalational group. TIVA was associated with a lower incidence of
POCD in the first 30 days postoperatively. Regarding the secondary objective, due to the small number of selected articles and its high heterogeneity, a metanalysis was not conducted. Given the heterogeneity of criteria for POCD, future prospective studies with more robust designs should be performed to fully address this question.