麻醉與阿茲海默症風險之相關性

The Correlation between Anesthesia and The Risk of Alzheimer's Disease

徐冠馨

麻醉方式 ； 阿茲海默症 ； 吸入性麻醉氣體 ； 年齡 ； Anesthesia ； Inhalational anesthetics ； Age

長榮大學醫務管理學系(所)學位論文

2017年

碩士

黃偉堯

繁體中文

背景：阿茲海默症占失智症類型之60-70%，自1906年首次被提出至今，尚無法有效治療，而相關致病因素仍未確立。目前以類澱粉蛋白與tau蛋白學說備受認同。普遍使用於全身麻醉的吸入性麻醉氣體造成動物大腦出現阿茲海默症相關病理變化與神經退化的現象，引發全身麻醉與阿茲海默症風險的疑慮，臨床實驗、病例對照研究與世代研究的結果各有不同。是以使用於全身麻醉的吸入性氣體對於阿茲海默症的風險仍有待進一步研究。 目的：探討全身麻醉與阿茲海默症風險的相關性。 方法：本研究設計採縱貫式研究，利用國家衛生研究院全民健康保險研究資料庫，收錄1997年1月1日至2010年12月31日間，首次接受麻醉且年齡介於20-105歲，排除首次接受麻醉前具阿茲海默症、失智症、腦血管疾病與創傷性腦損傷個案。並控制年齡、性別、高血壓、第二型糖尿病、憂鬱症與共病指數，以Cox比例風險模型分析麻醉與阿茲海默症風險之相關性，並進而觀察65歲以上與65歲以下接受全身麻醉的阿茲海默症風險差異。 結果：全身麻醉相較於區域麻醉，阿茲海默症風險比為1.146， 95%信賴區間為0.978-1.343，統計上未達顯著差異。65歲以上全身麻醉相較於區域麻醉，其阿茲海默症風險比為0.984，95%信賴區間為0.829-1.167，未達統計顯著差異。65歲以下全身麻醉相較於區域麻醉，其阿茲海默症風險比為1.637，95%信賴區間為1.030-2.601，達統計顯著差異。 全身麻醉的次數增加，其阿茲海默症風險比為1.073，95%信賴區間為1.026-1.123，達統計顯著差異；65歲以上全身麻醉次數增加，其阿茲海默症風險比為1.026，95%信賴區間為0.962-1.093，統計上未達顯著差異；65歲以下全身麻醉次數增加，其阿茲海默症風險比為1.090，95%信賴區間為1.012-1.174，達統計顯著差異。 結論：整體而言全身麻醉不會增加阿茲海默症風險；然而全身麻醉次數增加，阿茲海默症風險顯著增加。65歲以上族群的阿茲海默症風險不受麻醉方式與全身麻醉次數影響，但65歲以下族群的阿茲海默症風險較容易受到麻醉方式與全身麻醉次數影響而增加。

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