Comparing The Influence Of Different Anesthesia Methods On The Incidence Of Cognitive Dysfunction After Joint Replacement Surgery

Objective: At present,patients undergoing lower limb joint replacement surgery,mainly including knee replacement and hip replacement,are usually under general anesthesia and neuraxial anesthesia.However,the two anesthesia methods are controversial for the incidence of postoperative cognitive dysfunction(POCD).This study intends to compare the difference between general anesthesia and neuraxial anesthesia for patients who undergo lower limb joint replacement surgery by using Cochrane systematic evaluation and Meta-analysis,so as to determine whether there is a difference in the incidence of short-term POCD and provide a reference for anesthesia for these patients.Methods: Search in the MEDLINE,Embase,Cochrane Library,CBM,Wan-fang,VIP as well as CNKI database via the computers.Search the library collection literature manually,trace the reference documents included in the literature,and collect and compare the randomized controlled trials(RCT)about POCD on the patients who undergo lower limb joint replacement surgery by using general anesthesia and neuraxial anesthesia.The search area is built to October 2018.According to the inclusion and exclusion criteria,two researchers screened the literature,extracted data,and made quality evaluations.The final literature was meta-analyzed using the Revman5.3Results: Finally,9 literatures and 11 RCTs were included in systematic review,which showed that:there were 3 researches about 3rd and 5th indicated that the difference is different between the general anesthesia group and the neuraxial group.Others showed that the difference between 2 groups is not statistical.Meta-analysis included 8 literatures and 10 RCTs.The total number of patients in the general anesthesia group was 553,and the total number of patients in the neuraxial anesthesia group was 561,totaling 1114.The incidence of short-term POCD was 14.47%(80/553)in general anesthesia group,8.38%(47/561)in neuraxial anesthesia group,and the incidence of short-term POCD in general anesthesia group was higher than that in neuraxial anesthesia group [OR=1.89,95%CI(1.28,2.77),P=0.001].Among them,the incidence of POCD was 28.00%(28/100)in the general anesthesia group and 10.00%(10/100)in the neuraxial anesthesia group on the 3rd day,which was higher in the general anesthesia group than in the neuraxial anesthesia group [OR=3.53,95%CI(1.60,7.76),P=0.002].The incidence of POCD was9.27%(23/248)in the general anesthesia group on the 5th day,and 6.45%(16/248)in the in-charge anesthesia group,with no statistical difference between the two groups[OR=1.49,95%CI(0.76,2.91),P=0.24].Postoperative cognitive dysfunction on 7th day was 14.15%(29/205)in the general anesthesia group and 9.86%(21/213)in the neuraxial anesthesia group,with no statistical difference between the two groups[OR=1.53,95%CI(0.84,2.81),P=0.17].The differences were mainly concentrated in the postoperative cognitive dysfunction before the 3rd day and after the 5th day.Conclusions: 1.In general,general anesthesia short-term incidence of POCD in the neuraxial anesthesia increases;2.The increased incidence of cognitive dysfunction after general anesthesia compared with neuraxial anesthesia was mainly observed on the 3rd day and before,and there was no significant difference in the incidence on the 5th day and the 7th day.However,due to the limited number of English literatures and high-quality studies included in the study,large samples and high-quality randomized controlled trials(RCTs)are needed to strengthen the persuasive power and demonstration strength of the conclusions,and provide strong evidence to verify the conclusions of this paper.