Whether the route of anaesthesia is an independent risk factor for dementia remains unclear. Literature research was done through PubMed, Embase, Cochrane Review, ISI Web of Science, and SCOPUS up to May 31, 2022. One population-based retrospective PSM cohort study demonstrated no association of dementia risk with general anaesthesia (GA) or regional anaesthesia among surgical patients. However, this study was limited by the inclusion of only elective surgery, a small sample size, and no data on surgical types. Another longitudinal duration of surgery study by using a sample cohort based on a nationwide population sample and demonstrated a significant positive association between GA and dementia. However, the study had a small sample size in the GA group, and the control group comprised those not undergoing anaesthesia.

本研究前的證據(jù)

目前尚不清楚麻醉途徑是否是癡呆的獨(dú)立風(fēng)險(xiǎn)因素。文獻(xiàn)研究通過(guò)PubMed、Embase、Cochrane Review、ISI Web of Science和SCOPUS進(jìn)行，截止日期為2022年5月31日。一項(xiàng)基于人群的回顧性PSM隊(duì)列研究表明，癡呆風(fēng)險(xiǎn)與全身麻醉無(wú)關(guān)。然而該研究?jī)H限于擇期手術(shù)，樣本量小，另一項(xiàng)基于全國(guó)人口樣本的隊(duì)列研究顯示GA與癡呆之間存在顯著的正相關(guān)，該研究在GA組中樣本量小，而對(duì)照組包括那些沒(méi)有進(jìn)行麻醉的患者。

The patients undergoing major elective surgery were categorised into three groups according to whether they received GA with or without inhalation anaesthetics or regional anaesthesia, matched at a 1:1 ratio. We determined the significant hazard ratios of dementia in surgical patients undergoing GA compared with those undergoing regional anaesthesia. Our findings suggested that surgical patients undergoing inhalation anaesthesia had a higher risk of dementia than those undergoing noninhalation anaesthesia.

本研究的附加值

根據(jù)患者是否接受GA聯(lián)合或不聯(lián)合吸入麻醉劑或區(qū)域麻醉，將接受重大擇期手術(shù)的患者分為三組，比例為1：1。我們確定了接受GA的手術(shù)患者與接受區(qū)域麻醉的患者相比癡呆的顯著風(fēng)險(xiǎn)比。我們的研究結(jié)果表明，接受吸入麻醉的手術(shù)患者比接受非吸入麻醉的患者有更高的癡呆風(fēng)險(xiǎn)。

To lower this health economic burden, determination of preventable risk factors for dementia is critical. This information, if our findings can be confirmed in a randomised controlled trial, can guide health policies in promoting early detection of dementia or dementia risk.

所有可用證據(jù)的含義

為了降低這一健康經(jīng)濟(jì)負(fù)擔(dān)，確定癡呆的可預(yù)防風(fēng)險(xiǎn)因素至關(guān)重要。如果我們的研究結(jié)果能夠在隨機(jī)對(duì)照試驗(yàn)中得到證實(shí)，這一信息可以指導(dǎo)衛(wèi)生政策，促進(jìn)癡呆或癡呆風(fēng)險(xiǎn)的早期檢測(cè)。

Whether the route of anaesthesia is an independent risk factor for dementia remains unclear. Therefore, we conducted a propensity score–matched (PSM) population-based cohort study to compare dementia incidence among surgical patients undergoing different routes of anaesthesia.

背景：麻醉方式是否是癡呆的獨(dú)立危險(xiǎn)因素尚不清楚，因此，我們進(jìn)行了一項(xiàng)基于人群的傾向評(píng)分匹配（PSM）隊(duì)列研究，以比較接受不同麻醉方式的手術(shù)患者的癡呆發(fā)生率。

The inclusion criteria were being an inpatient >20 years of age who underwent major elective surgery, defined as those requiring GA without or with inhalation anaesthetics or regional anaesthesia, and being hospitalised for >1 day between Jan 1, 2008 and Dec 31, 2019 in Taiwan. Patients undergoing major elective surgery were categorised into three groups according to the type of anaesthesia administered: noninhalation anaesthesia, inhalation anaesthesia, and regional anaesthesia, matched at a 1:1 ratio. The incidence rate (IR) of dementia was determined.

方法：入選標(biāo)準(zhǔn)為2008年1月1日至2019年12月31日期間在中國(guó)臺(tái)灣接受擇期大手術(shù)的住院患者，年齡〉20歲，定義為需要全麻（不使用或使用吸入麻醉劑）或局部麻醉，住院時(shí)間〉1天。根據(jù)麻醉類(lèi)型，將接受擇期大手術(shù)的患者分為3組：非吸入麻醉、吸入麻醉和局部麻醉，按1：1比例匹配。測(cè)定癡呆的發(fā)生率。

PSM yielded 63,750 patients (21,250 in the noninhalation anaesthesia group, 21,250 in the inhalation anaesthesia group, and 21,250 in the regional anaesthesia group). In the multivariate Cox regression analysis, the adjusted hazard ratios (aHRs; 95% confidence intervals) of dementia for the inhalation and noninhalation anaesthesia groups compared with the regional anaesthesia group were 20.16 (15.40–26.35; p < 0.001) and 18.33 (14.03–24.04; p < 0.001), respectively. The aHR of dementia for inhalation anaesthesia compared with noninhalation anaesthesia was 1.13 (1.03–1.22; p = 0.028). The IRs of dementia for the inhalation, noninhalation, and regional anaesthesia groups were 3647.90, 3492.00, and 272.99 per 100,000 person-years, respectively.

結(jié)果：PSM共納入63，750例患者（非吸入麻醉組21，250例，吸入麻醉組21，250例，局部麻醉組21，250例）。在多變量Cox回歸分析中，與區(qū)域麻醉組相比，吸入麻醉組和非吸入麻醉組癡呆的校正危險(xiǎn)比（aHRs；95%置信區(qū)間）分別為20.16（15.40–26.35；p<0.001）和18.33（14.03–24.04；p<0.001）。吸入麻醉與非吸入麻醉癡呆的aHR分別為1.13（1.03-1.22; p = 0.028)。吸入麻醉組、非吸入麻醉組和局部麻醉組癡呆的發(fā)生率分別為3647.90、3492.00和272.99/100，000人-年。

In this population based cohort study, the incidence of dementia among surgical patients undergoing general anaesthesia was higher than among those undergoing regional anaesthesia. Among patients undergoing general anaesthesia, inhalation anaesthesia was associated with a higher risk of dementia than noninhalation anaesthesia. Our results should be confirmed in a randomised controlled trial.

解讀：在這項(xiàng)基于人群的隊(duì)列研究中，接受全身麻醉的手術(shù)患者中癡呆的發(fā)生率高于接受區(qū)域麻醉的患者。在接受全身麻醉的患者中，吸入麻醉與癡呆的風(fēng)險(xiǎn)高于非吸入麻醉。我們的結(jié)果應(yīng)在隨機(jī)對(duì)照試驗(yàn)中得到證實(shí)。

接受不同麻醉方式（全身麻醉伴或不伴吸入麻醉和局部麻醉）的傾向評(píng)分匹配的手術(shù)患者中癡呆的累積發(fā)生率。

對(duì)接受非吸入或吸入全身麻醉的外科患者進(jìn)行年齡和合并癥的敏感性分析

文獻(xiàn)/RIOZHOU

排版/叮當(dāng)丸子麻