刘波　刘江锋　郝恒瑞

[摘要] 目的 对全身麻醉或椎管内麻醉下肢骨折术后认知障碍的发生率的国内外相关文献进行荟萃分析。 方法 对万方、中国知网、维普、PubMed、Cochrane、EMbase等数据库2013年1月～2018年2月公开发表的关于下肢骨折术中全身麻醉与椎管内麻醉对术后认知障碍影响的相关研究报道进行检索，由2名工作人员按照文献纳入、排除标准和技术路线图进行筛选，并借助Cochrane手册中的随机试验的偏倚风险评估工具对文献质量进行评价，然后采用RevMan 5.1软件对检索文献进行Meta分析。 结果 本研究共提取10篇国内外相关报道，共8篇国内文献，2篇国外文献；所有文献中共纳入925例患者，其中采用全身麻醉的患者共有415例，采用椎管内麻醉的患者共有510例。异质性检验结果发现P = 0.42，I2 = 0；经固定效应模型分析可知实施全身麻醉的下肢骨折患者术后认知障碍的发生风险明显高于椎管内麻醉的下肢骨折患者（RR = 1.40，95%CI：1.04～1.88，P = 0.04）；偏倚风险分析结果并未发现有明显的偏倚。 结论 在下肢骨折患者手术中应用全身麻醉后认知障碍的发生风险明显高于椎管内麻醉。

[关键词] 全身麻醉；椎管内麻醉；下肢骨折；术后认知障碍

[中图分类号] R749.16 [文献标识码] A [文章编号] 1673-7210（2018）04（b）-0112-04

[Abstract] Objective To analyze on the domestic and foreign literature on the incidences of cognitive impairment of general anesthesia or intraspinal anesthesia after lower extremity fractures by Meta analysis. Methods The related research reports published on Chinese Wanfang， PubMed， VIP， CNKI， Cochrane and EMbase databases from January 2013 to February 2018 on the incidences of cognitive impairment of general anesthesia or intraspinal anesthesia after lower extremity fractures were selected. Two staff members were screened in accordance with the documentation， exclusion criteria and technical roadmap. The quality of the literature was evaluated by the bias risk assessment tool in the Cochrane manual. Then RevMan 5.1 software was used to analyze the retrieved literature by Meta analysis. Results In this study， 10 domestic and foreign related reports were extracted， including 8 domestic documents and 2 foreign documents. In all of the literature， 925 patients were included， among which 415 cases were treated with general anesthesia， and 510 patients were treated with intraspinal anaesthesia. The results of heterogeneity test showed P = 0.42， I2 = 0. After fixed effect model analysis， it was found that the risk of postoperative cognitive dysfunction after general anesthesia for patients with lower limb fractures was significantly higher than that of patients with lower extremity fracture treated by spinal anesthesia （RR = 1.40， 95%CI： 1.04-1.88， P = 0.04）. The results of the bias risk analysis was not found obvious bias. Conclusion The risk of cognitive impairment after general anesthesia in patients with lower extremity fractures is significantly higher than that in spinal canal anesthesia.

[Key words] General anesthesia； Intraspinal anesthesia； Fractures of the lower extremities； Postoperative cognitive impairment

負重和行走是下肢的主要功能，必须保持一个良好的稳定结构，而双下肢等长是维持下肢良好的稳定结构的重要前提。当下肢骨折发生后，稳定结构被打破，下肢功能受到严重的阻碍。据调查显示[1]，下肢骨折的发生率随着交通行业和建筑行业的不断发展逐年升高，且在此类患者中需要手术者的构成比已经超过60%。……