Cognitive impairment induced by sevoflurane anesthesia is mediated by the cholinergic system after gastrointestinal surgery in older patients: A randomized, controlled trial
Cognitive impairment induced by sevoflurane anesthesia is mediated by the cholinergic system after gastrointestinal surgery in older patients: A randomized, controlled trial
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DOI：
10.1002/ibra.12079
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发表时间：
2022-11
期刊：
影响因子：
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通讯作者：
Xingxing Liu;Qing Yang;Yi Guo;M. He;Zhen‐He Yu;Qi Tian;Zhao‐Qiong Zhu
中科院分区：
文献类型：
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作者：
Xingxing Liu;Qing Yang;Yi Guo;M. He;Zhen‐He Yu;Qi Tian;Zhao‐Qiong Zhu
手术后神经认知恢复延迟与发病率和死亡率增加相关。本研究在遵义医学院附属医院进行了一项前瞻性、双盲、随机对照试验。接受胃肠道手术的老年患者（65岁及以上）被随机分为七氟烷麻醉组或丙泊酚麻醉组。进行简易精神状态检查以评价认知功能。采集外周静脉血检测胆碱乙酰转移酶和乙酰胆碱酯酶水平。共入组75例患者，每组30例患者完成研究。术后第1天，七氟烷组患者在简易精神状态检查中的表现比丙泊酚组患者差。与术后1天使用丙泊酚麻醉的患者相比，使用七氟烷麻醉的患者血液胆碱乙酰转移酶浓度较低，乙酰胆碱酯酶浓度较高。术后3天，无论简易精神状态检查评分或胆碱乙酰转移酶和乙酰胆碱酯酶水平如何，使用七氟烷或丙泊酚全身麻醉的患者均无差异。七氟烷麻醉对老年手术患者的神经认知恢复有短期延迟，这可能与中枢胆碱能系统变性有关。
Delayed neurocognitive recovery after surgery is associated with increased morbidity and mortality. However, its mechanism of action remains controversial and complex. A prospective, double‐blind, randomized controlled trial was performed at the Affiliated Hospital of Zunyi Medical University. Older patients (aged 65 years and older) who underwent gastrointestinal surgery were randomly divided into sevoflurane‐based or propofol‐based anesthesia groups. The Mini‐Mental State Examination was performed to evaluate cognitive function. Peripheral venous blood was collected to test the levels of choline acetyltransferase and acetylcholinesterase. A total of 75 patients were enrolled and 30 patients in each group completed the study. On Day 1 postoperation, patients in the sevoflurane group showed worse performance on the Mini‐Mental State Examination than patients in the propofol group. Lower blood choline acetyltransferase concentrations and higher acetylcholinesterase concentrations were observed in patients who had sevoflurane anesthesia than in patients who had propofol anesthesia 1 day postoperative. At 3 days postoperation, patients with sevoflurane‐ or propofol‐based general anesthesia did not differ regardless of Mini‐Mental State Examination score or choline acetyltransferase and acetylcholinesterase levels. Sevoflurane‐based anesthesia has short‐term delayed neurocognitive recovery in older surgical patients, which may be related to central cholinergic system degeneration.