全身麻醉藥物與手術后認知功能障礙_《華西醫學》

作者：

周裕凱 ¹ ,  張蘭 ²

1 德陽市人民醫院麻醉科（四川德陽，618000）;2 四川省骨科醫院麻醉科;

關鍵詞：

吸入麻醉藥靜脈麻醉藥手術后認知功能障礙

視頻：

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全身麻醉藥物被認為是造成手術后認知功能障礙的重要因素之一，前期實驗大都是推理性和描述性的，樣本規模小，不能充分說明兩者間的關系。為今后從大腦神經元形態學和神經生物學研究方面獲得突破，現從吸入麻醉藥、靜脈麻醉藥各自對認知功能的影響和可能機制，以及不同麻醉藥的比較等方面進行綜述。

引用本文： 周裕凱,張蘭. 全身麻醉藥物與手術后認知功能障礙. 華西醫學, 2012, 27(10): 1588-1590. doi: 復制

1.	Bedford PD. Adverse cerebral effects of anaesthesia on old people [J]. Lancet, 1955, 269(6884): 259-263.
2.	Moller JT, Cluitmans P, Rasmussen LS, et al. Long-term postoperative congnitive dysfunction in the elderly: ISPOCD1 study [J]. Lancet, 1998, 351(9106): 857-861.
3.	Bitsch M, Foss N, Kristensen B, et al. Pathogenesis of and management strategies for postoperative delirium after hipfracture [J]. Acta Orthopaedica Scandinavica, 2004, 75(4): 378-389.
4.	Abildstrom H, Rasmussen LS, Rentowl P, et al. Cognitive dysfunction 1-2 years after non-cardiac surgery in the elderly. International study of post-operative cognitive dysfunction [J]. Acta Anaesthesiol Scandinavica, 2000, 44(10): 1246-1251.
5.	Billig N, Stockton P, Cohen-Mansfield J, et al. Cognitive and affective changes after cataract surgery in an elderly population [J]. Am J Geria Psychiat, 1996, 4(1): 29-38.
6.	Culley DJ, Baxter MG, Yukhananov R, et al. Long-term impairment of acquisition of a spatial memory task following isoflurane-nitrous oxide anesthesia in rats [J]. Anesthesiology, 2004, 100(2): 309-314.
7.	Chen X, Zhao M, White PF , et al. The recovery of cognitive function after general anesthesia in elderly patients: a comparison of desflurane and sevoflurane [J]. Anesthesia Analgesia, 2001, 93(6): 1489-1494.
8.	Levin ED, Bradley A, Addy N, et al. Hippocampal α7 and α4β2 nicotinic receptors and working memory [J]. Neuroscience, 2002, 109(4): 757-765.
9.	Simon W, Hapfelmeier G, Kochs E, et al. Isoflurane blocks synaptic plasticity in the mouse hippocampus [J]. Anesthesiology, 2001, 94(4): 1058-1065.
10.	Eckenhoff RG, Johansson JS, Wei H, et al. Inhaled anesthetic enhancement of amyloid-beta oligomerization and cytotoxicity [J]. Anesthesiology, 2004, 101(3): 703-709.
11.	Wei H, Kang B, Wei W, et al. Isoflurane and sevoflurane affect cell survival and BCL-2/BAX ratio differently [J]. Brain Res, 2005, 1037(1/2): 139-147.
12.	Bekker A, Shah R, Quartermain D, et al. Isoflurane preserves spatial working memory in adult mice after moderate hypoxia [J]. Anesthesia Analgesia, 2006, 102(4): 1134-1138.
13.	王賢裕, 田玉科, 楊輝, 等. 腹腔重復注射小劑量氯胺酮術后鎮痛對趾部切口術大鼠認知功能的影響 [J]. 中華麻醉學雜志, 2005, 25(3): 205-207.
14.	Morgan CJ, Mofeez A, Brandner B, et al. Ketamine impairs response inhibition and is positively reinforcing in healthy volunteers: a dose-response study [J]. Psychopharmacology, 2004, 172(3): 298-308.
15.	Rowland LM, Astur RS, Jung RE, et al. Selective cognitive impairments associated with nmda receptor blockade in humans [J]. Neuropsychopharmacology, 2005, 30(3): 633-639.
16.	Lee IH, Culley DJ, Baxter MG, et al. Spatial memory is intact in aged rats after propofol anesthesia [J]. Anesthesia Analgesia, 2008, 107(4): 1211-1215.
17.	Seidl S, Hausmann R, Neisser J, et al. Severity and duration of mental deficiency symptoms after intravenous administration of propofol [J]. Int J Legal Med, 2007, 121(4): 281-285.
18.	Dowd NP, Karski JM, Cheng DC, et al. Fast-track cardiac anaesthesia in the elderly: effect of two different anaesthetic techniques on mental recovery [J]. Br J Anaesth, 2001, 86(1): 68-76.
19.	Murphy SE, Downham C, Cowen PJ, et al. Direct effects of diazepam on emotional processing in healthy volunteers [J]. Psychopharmacology, 2008, 199(4): 503-513.
20.	Rasmussen LS, Steentoft A, Rasmussen H, et al. Benzodiazepines and postoperative cognitive dysfunction in the elderly. ISPOCD Group. International study of postoperrative cognitive dysfunction [J]. Br J Anaesth, 1999, 83(4 ): 585-589.
21.	Dixon CE, Ma XC, Kline AE, et al. Acute etomidate treatment reduces cognitive deficits and histopathology in rats with traumatic brain injury [J]. Critical care medicine, 2003, 31(8): 2222-2227.
22.	Sabatowski R, Schwalen S, Rettig K, et al. Driving ability under long-term treatment with transdermal fentanyl [J]. J Pain Symptom Manage, 2003, 25(1): 38-47.
23.	Silbert BS, Scott DA, Evered LA, et al. A comparison of the effect of high- and low-dose fentanyl on the incidence of postoperative cognitive dysfunction after coronary artery bypass surgery in the elderly [J]. Anesthesiology, 2006, 104(6): 1137-1145.
24.	Jindal R, Kumra VP, Naranl KK, et al. Comparison of maintenance and emergence characteristics after desflurane or sevoflurane in outpatient anaesthesia [J]. Indian J Anaesth, 2011, 55(1): 36-42.
25.	Larsen B, Seitz A, Larsen R. Recovery of cognitive function after remifentanil-propofol anesthesia: a comparison with desflurane and sevoflurane anesthesia [J]. Anesthesia Analgesia, 2000, 90(1): 168-174.
26.	Munte S, Munte TF, Kuche H, et al. General anesthesia for interventional neuroradiology: propofol versus isoflurane [J]. J Clin Anesth, 2001, 13(3): 186-192.

1. 　Bedford PD. Adverse cerebral effects of anaesthesia on old people [J]. Lancet, 1955, 269(6884): 259-263.
2. 　Moller JT, Cluitmans P, Rasmussen LS, et al. Long-term postoperative congnitive dysfunction in the elderly: ISPOCD1 study [J]. Lancet, 1998, 351(9106): 857-861.
3. 　Bitsch M, Foss N, Kristensen B, et al. Pathogenesis of and management strategies for postoperative delirium after hipfracture [J]. Acta Orthopaedica Scandinavica, 2004, 75(4): 378-389.
4. 　Abildstrom H, Rasmussen LS, Rentowl P, et al. Cognitive dysfunction 1-2 years after non-cardiac surgery in the elderly. International study of post-operative cognitive dysfunction [J]. Acta Anaesthesiol Scandinavica, 2000, 44(10): 1246-1251.
5. 　Billig N, Stockton P, Cohen-Mansfield J, et al. Cognitive and affective changes after cataract surgery in an elderly population [J]. Am J Geria Psychiat, 1996, 4(1): 29-38.
6. 　Culley DJ, Baxter MG, Yukhananov R, et al. Long-term impairment of acquisition of a spatial memory task following isoflurane-nitrous oxide anesthesia in rats [J]. Anesthesiology, 2004, 100(2): 309-314.
7. 　Chen X, Zhao M, White PF , et al. The recovery of cognitive function after general anesthesia in elderly patients: a comparison of desflurane and sevoflurane [J]. Anesthesia Analgesia, 2001, 93(6): 1489-1494.
8. 　Levin ED, Bradley A, Addy N, et al. Hippocampal α7 and α4β2 nicotinic receptors and working memory [J]. Neuroscience, 2002, 109(4): 757-765.
9. 　Simon W, Hapfelmeier G, Kochs E, et al. Isoflurane blocks synaptic plasticity in the mouse hippocampus [J]. Anesthesiology, 2001, 94(4): 1058-1065.
10. 　Eckenhoff RG, Johansson JS, Wei H, et al. Inhaled anesthetic enhancement of amyloid-beta oligomerization and cytotoxicity [J]. Anesthesiology, 2004, 101(3): 703-709.
11. 　Wei H, Kang B, Wei W, et al. Isoflurane and sevoflurane affect cell survival and BCL-2/BAX ratio differently [J]. Brain Res, 2005, 1037(1/2): 139-147.
12. 　Bekker A, Shah R, Quartermain D, et al. Isoflurane preserves spatial working memory in adult mice after moderate hypoxia [J]. Anesthesia Analgesia, 2006, 102(4): 1134-1138.
13. 　王賢裕, 田玉科, 楊輝, 等. 腹腔重復注射小劑量氯胺酮術后鎮痛對趾部切口術大鼠認知功能的影響 [J]. 中華麻醉學雜志, 2005, 25(3): 205-207.
14. 　Morgan CJ, Mofeez A, Brandner B, et al. Ketamine impairs response inhibition and is positively reinforcing in healthy volunteers: a dose-response study [J]. Psychopharmacology, 2004, 172(3): 298-308.
15. 　Rowland LM, Astur RS, Jung RE, et al. Selective cognitive impairments associated with nmda receptor blockade in humans [J]. Neuropsychopharmacology, 2005, 30(3): 633-639.
16. 　Lee IH, Culley DJ, Baxter MG, et al. Spatial memory is intact in aged rats after propofol anesthesia [J]. Anesthesia Analgesia, 2008, 107(4): 1211-1215.
17. 　Seidl S, Hausmann R, Neisser J, et al. Severity and duration of mental deficiency symptoms after intravenous administration of propofol [J]. Int J Legal Med, 2007, 121(4): 281-285.
18. 　Dowd NP, Karski JM, Cheng DC, et al. Fast-track cardiac anaesthesia in the elderly: effect of two different anaesthetic techniques on mental recovery [J]. Br J Anaesth, 2001, 86(1): 68-76.
19. 　Murphy SE, Downham C, Cowen PJ, et al. Direct effects of diazepam on emotional processing in healthy volunteers [J]. Psychopharmacology, 2008, 199(4): 503-513.
20. 　Rasmussen LS, Steentoft A, Rasmussen H, et al. Benzodiazepines and postoperative cognitive dysfunction in the elderly. ISPOCD Group. International study of postoperrative cognitive dysfunction [J]. Br J Anaesth, 1999, 83(4 ): 585-589.
21. 　Dixon CE, Ma XC, Kline AE, et al. Acute etomidate treatment reduces cognitive deficits and histopathology in rats with traumatic brain injury [J]. Critical care medicine, 2003, 31(8): 2222-2227.
22. 　Sabatowski R, Schwalen S, Rettig K, et al. Driving ability under long-term treatment with transdermal fentanyl [J]. J Pain Symptom Manage, 2003, 25(1): 38-47.
23. 　Silbert BS, Scott DA, Evered LA, et al. A comparison of the effect of high- and low-dose fentanyl on the incidence of postoperative cognitive dysfunction after coronary artery bypass surgery in the elderly [J]. Anesthesiology, 2006, 104(6): 1137-1145.
24. 　Jindal R, Kumra VP, Naranl KK, et al. Comparison of maintenance and emergence characteristics after desflurane or sevoflurane in outpatient anaesthesia [J]. Indian J Anaesth, 2011, 55(1): 36-42.
25. 　Larsen B, Seitz A, Larsen R. Recovery of cognitive function after remifentanil-propofol anesthesia: a comparison with desflurane and sevoflurane anesthesia [J]. Anesthesia Analgesia, 2000, 90(1): 168-174.
26. 　Munte S, Munte TF, Kuche H, et al. General anesthesia for interventional neuroradiology: propofol versus isoflurane [J]. J Clin Anesth, 2001, 13(3): 186-192.

《華西醫學》

全身麻醉藥物與手術后認知功能障礙

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《華西醫學》

全身麻醉藥物與手術后認知功能障礙

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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