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

全身麻醉藥物被認(rèn)為是造成手術(shù)后認(rèn)知功能障礙的重要因素之一，前期實(shí)驗(yàn)大都是推理性和描述性的，樣本規(guī)模小，不能充分說明兩者間的關(guān)系。為今后從大腦神經(jīng)元形態(tài)學(xué)和神經(jīng)生物學(xué)研究方面獲得突破，現(xiàn)從吸入麻醉藥、靜脈麻醉藥各自對(duì)認(rèn)知功能的影響和可能機(jī)制，以及不同麻醉藥的比較等方面進(jìn)行綜述。

引用本文： 周裕凱,張?zhí)m. 全身麻醉藥物與手術(shù)后認(rèn)知功能障礙. 華西醫(yī)學(xué), 2012, 27(10): 1588-1590. doi: 復(fù)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(fù)注射小劑量氯胺酮術(shù)后鎮(zhèn)痛對(duì)趾部切口術(shù)大鼠認(rèn)知功能的影響 [J]. 中華麻醉學(xué)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. 1. 　Bedford PD. Adverse cerebral effects of anaesthesia on old people [J]. Lancet, 1955, 269(6884): 259-263.
  2. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 13. 　王賢裕, 田玉科, 楊輝, 等. 腹腔重復(fù)注射小劑量氯胺酮術(shù)后鎮(zhèn)痛對(duì)趾部切口術(shù)大鼠認(rèn)知功能的影響 [J]. 中華麻醉學(xué)雜志, 2005, 25(3): 205-207.
  14. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.