(30)麻醉-Anaesthesia-公开课-关爱惟士
(30)麻醉-Anaesthesia

课程视频:http://player.youku.com/embed/XMjY3ODM4NzE0NA


Associate Professor Mathew Summers


There is anecdotal evidence, and some research, suggesting that in older adults, exposure to a general anaesthetic may result in activation of cognitive decline and dementia, post-surgery. That’s become an increasing area of interest. The hypothesis is that something is happening during the general anaesthetic, either the chemical or the process of anaesthesia, that’s changing brain chemistry or function, and that’s triggering a development of a dementia, following the exposure to general anaesthetic.

有轶事证据和一些研究表明当老年人暴露于全身麻醉手术后,可能会发生认知衰退和痴呆。这成为一个越来越感兴趣的研究领域。这个假设是在全身麻醉期间麻醉的化学和麻醉过程会改变大脑的化学或功能,并且暴露于全身麻醉后会触发患认知症。


At this stage, the recommendation to avoid general anaesthetic for risk of dementia is not founded. There’s not sufficient evidence to suggest that. There are large scale studies that have shown an increased risk of dementia following general anaesthetic. There’s an equivalent large scale study that found no increased risk of dementia following a general anaesthetic, and there’s a third large study that showed decreased risk of dementia following a general anaesthetic. So again, the research is all over the place. We don’t have very clear randomised control trial evidence in humans that general anaesthetic is negative. The research is based on retrospective correlational studies.

在这个阶段,避免全身麻醉痴呆风险的建议还没有被确立,也没有足够的证据来证明。有个大规模研究表明,在全身麻醉后患痴呆的风险会增加。有一个等效的大规模研究发现在全身麻醉后的痴呆风险没有增加,第三个大型研究显示全身麻醉后患痴呆的风险降低。再次,研究到处都是。我们在人类中没有非常明确的随机对照试验证据表明全身麻醉是阴性的。该研究是基于回顾性相关研究。


The way we can look at why anaesthesia is being linked as a concern for dementia, comes down to the notion of causality. The research that we have is retrospective, in that we look at people who have developed dementia and we see that there’s a higher rate of those people who have dementia who may have had general anaesthetic in the last five to ten years, than the same age that don’t have general anaesthetic. The difficulty with such retrospective correlational studies is they don’t demonstrate causation. They demonstrate coincidences, two things that happened at the same time. The way that we need to go forward is with much better research, to identify what the underlying mechanisms are. And there are a range of possible explanations. Even if we do find that general anaesthetic has a higher rate of dementia in older people, it still doesn’t mean that anaesthetic is the causal mechanism. The person needed surgery for a reason. They may have had another condition that increases their risk for dementia, independent of general anaesthetic. During the process of general anaesthetic there are changes in brain chemistry and brain function and brain activation. That may be the cause. There are secondary complications that happen because of the medical condition that they suffered from that may cause that. They may have already had dementia, and the reason that we notice when they’re in hospital that they have dementia, is because in the community, with early stage dementia, with all their routines and structures around them, no-one noticed. And it’s when we put that person in an unfamiliar environment such as a hospital, with lots of supervision and monitoring, that people are starting to notice that person’s cognitive functions aren’t quite as sharp as they should be. And medical practitioners start to take notice that their memory’s not working too well, and assessment happens and they’re discovered to have dementia. But that has nothing to do with a general anaesthetic. They always had those symptoms, they just weren’t noticed. So we just don’t know where in that puzzle the anaesthetic comes in.

我们观察为什么麻醉与痴呆相关联的原因,其观察方式归结为因果关系的概念。我们所进行的研究是回顾性的,因为我们研究已经发生认知症的人,我们看到在过去五到十年内做过全身麻醉的人,比没有做做过全身麻醉同年龄的人,患认知症的比例更高。这种回顾性相关研究的困难是他们无法证明因果关系。能证明的只是同时发生两件事的巧合。我们需要向前迈进的方法是用更好的研究来确定底层机制究竟是什么,并且这有一个可能的解释范围。即使我们发现全身麻醉导致老年人较高的痴呆率,但它仍然不意味着麻醉是因果机制。该人需要手术是有原因的。他们可能有独立于全身麻醉之外的另一个病理条件增加他们的痴呆风险。可能的原因是,在全身麻醉的过程中,脑化学、脑功能和脑激活有变化。因为他们遭受的医疗条件,可能会导致有二次并发症发生。他们可能已经患有认知症,我们注意到他们在医院时有认知症的原因是因为在社区,周围的所有常规和结构,没有人注意到早期阶段的痴呆。当我们把这个人置于一个陌生的环境,如医院,有很多的监督和监测,人们开始注意到,人的认知功能不如他们应该的那么锐利。而医生开始注意到他们的记忆工作不太好,通过评估他们被发现有认知症。但这与全身麻醉无关。他们总是有这些症状,他们只是没有注意到。所以我们不知道麻醉剂带来的那个难题的谜底在哪里。


翻译:关爱惟士-未经允许不得转载,违者必追究法律责任

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