全身麻醉药物选择与老年手术患者预后:吸入麻醉还是静脉麻醉

背景 随着社会人口的老龄化,需要接受手术治疗的老年患者越来越多,麻醉管理对老年患者预后的影响值得关注. 目的 回顾吸入麻醉与静脉麻醉对老年手术患者预后的影响. 内容 对于心脏手术患者,吸入麻醉可能较丙泊酚静脉麻醉更有优势,但需进一步多中心、大规模临床研究证实.在对术后近期脑功能的影响方面,不同研究的结果差异较大,还无法得出明确结论;在对术后远期脑功能的影响方面,全身麻醉可能伴随术后痴呆风险增加,但还有待前瞻性研究证实.在对恶性肿瘤患者术后机体免疫功能的影响方面,丙泊酚静脉麻醉可能优于吸入麻醉,但其临床意义有待阐明;麻醉药物对恶性肿瘤患者肿瘤侵袭性及远期预后的影响值得进一步研究. 趋向 吸入麻醉与静脉麻醉对老年手术患者预后的影响,需要进一步的研究证实.

The choice of the anesthetics and outcome in elder surgical patients: inhalation anesthetics or intravenous anesthetic

Background As the population ages,elderly patients requiring surgery are increasing.The impact of anesthetic management on the outcome of elderly surgical patients deserves more attention.Objective The review focuses on the effects of inhalational versus intravenous anesthetics on the outcome of elderly surgical patients.Content For patients undergoing cardiac surgery,inhalational anesthesia may have more advantages than propofol intravenous anesthesia,but this effect requires further confirmation by multicenter,large sample size,randomized controlled trials.In terms of short-term postoperative brain function,current results are conflicting and no clear conclusion can be reached.With regard to long-term postoperative brain function,retrospective studies showed that general anesthesia may be associated with increased risk of dementia,but this need to be confirmed by prospective studies with long-term follow-up.For patients with malignant tumor,propofol intravenous anesthesia may be superior to inhalational anesthesia in the aspect of immune function after surgery,but the clinical significance of this effect is not totally clear.The effects of anesthetics on tumor invasiveness and long-term outcome of patients with malignant tumor deserve further study.Trend The effects of inhalational versus intravenous anesthetics on the outcome of elderly surgical patients deserve further studies.