The effects of isoflurane and desflurane on cognitive function in humans.
The effects of isoflurane and desflurane on cognitive function in humans.
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DOI：
10.1213/ane.0b013e31823b2602
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发表时间：
2012-02
影响因子：
5.7
通讯作者：
Xie Z
中科院分区：
文献类型：
--
作者：
Zhang B;Tian M;Zhen Y;Yue Y;Sherman J;Zheng H;Li S;Tanzi RE;Marcantonio ER;Xie Z
术后认知功能下降（POCD）的病因仍有待确定。麻醉剂异氟烷（而非地氟烷）可能诱导神经毒性。然而，这些影响的功能后果尚未评估。因此，我们进行了一项初步研究，以确定异氟烷和地氟烷对人类认知功能的影响。受试者包括通过随机化在单独脊髓麻醉（S，n = 15）、脊髓+地氟烷麻醉（SD，n = 15）或脊髓+异氟烷麻醉（SI，n = 15）下进行下肢或腹部手术的患者。每例受试者在麻醉和手术前即刻和手术后1周接受认知测试，由对麻醉方案不知情的研究者进行。POCD是使用这些测试的分数来定义的。我们研究了45名受试者，24名男性和21名女性。受试者的平均年龄为69.0 ± 1.9岁。治疗组之间的年龄和其他特征无显著差异。S、SD和SI组中认知功能下降的平均次数分别为1.13、1.07和1.40。麻醉后SI组POCD发生率（27%）高于S组（0%），但SD组无显著差异（P = 0.028）。我们的初步研究结果表明，异氟烷和地氟烷可能对术后认知功能有不同的影响，需要进行更多的研究，样本量更大，随访测试时间更长。
The etiology of postoperative cognitive decline (POCD) remains to be determined. Anesthetic isoflurane, but not desflurane, may induce neurotoxicity. However, the functional consequences of these effects have not been assessed. We therefore performed a pilot study to determine the effects of isoflurane and desflurane on cognitive function in humans. The subjects included patients who had lower extremity or abdominal surgery under spinal anesthesia alone (S, n = 15), spinal plus desflurane anesthesia (SD, n = 15), or spinal plus isoflurane anesthesia (SI, n = 15) by randomization. Each of the subjects received cognitive tests immediately before and 1 week after anesthesia and surgery administered by an investigator who was blinded to the anesthesia regimen. POCD was defined using the scores from each of these tests. We studied 45 subjects, 24 males and 21 females. The mean age of the subjects was 69.0 ± 1.9 years. There was no significant difference in age and other characteristics among the treatment arms. The mean number of cognitive function declines in the S, SD, and SI groups was 1.13, 1.07, and 1.40, respectively. POCD incidence after SI (27%), but not SD (0%), anesthesia was higher than that after S (0%), P = 0.028 (3-way comparison). These findings from our pilot study suggest that isoflurane and desflurane may have different effects on postoperative cognitive function, and additional studies with a larger sample size and longer times of follow-up testing are needed.