实用老年医学 ›› 2024, Vol. 38 ›› Issue (5): 447-437.doi: 10.3969/j.issn.1003-9198.2024.05.004
赵倩文, 孙斌, 朱杨子, 顾小萍, 王立伟
收稿日期:
2024-02-02
出版日期:
2024-05-20
发布日期:
2024-05-23
通讯作者:
王立伟,Email: doctorlww@sina.com
作者简介:
王立伟 主任医师
Received:
2024-02-02
Online:
2024-05-20
Published:
2024-05-23
摘要: 老年病人术后认知功能障碍(POCD)发生率高,会对病人术后产生众多不良影响。POCD延缓病人术后恢复,增加死亡风险,并可能导致认知功能的持续下降,严重影响老年人的生活质量。早期识别POCD和采取有效防治措施可降低POCD的发生,对老年病人尤为重要。本文主要阐述POCD诊断、预防和治疗的最新研究进展,为临床实践和未来研究提供参考。
中图分类号:
赵倩文, 孙斌, 朱杨子, 顾小萍, 王立伟. 老年病人术后认知功能障碍诊断与干预策略的研究进展[J]. 实用老年医学, 2024, 38(5): 447-437.
[1] ALMUZAYYEN H A, CHOWDHURY T, ALGHAMDI A S. Postoperative cognitive recovery and prevention of postoperative cognitive complications in the elderly patient[J]. Saudi J Anaesth, 2023, 17(4): 550-556. [2] MIGIROV A, CHAHAR P, MAHESHWARI K. Postoperative delirium and neurocognitive disorders[J]. Curr Opin Crit Care, 2021, 27(6): 686-693. [3] BHUSHAN S, LI Y, HUANG X, et al. Progress of research in postoperative cognitive dysfunction in cardiac surgery patients: a review article[J]. Int J Surg, 2021, 95: 106163. [4] ALAM A, HANA Z, JIN Z, et al. Surgery, neuroinflammation and cognitive impairment[J]. EBioMedicine, 2018, 37: 547-556. [5] KLEINDIENST A, HESSE F, BULLOCK M R, et al. The neurotrophic protein S100B: value as a marker of brain damage and possible therapeutic implications[J]. Prog Brain Res, 2007, 161: 317-325. [6] HE X, WEN L J, CUI C, et al. The significance of S100β protein on postoperative cognitive dysfunction in patients who underwent single valve replacement surgery under general anesthesia[J]. Eur Rev Med Pharmacol Sci, 2017, 21(9): 2192-2198. [7] QIAN G, WANG Y. Serum metabolomics of early postoperative cognitive dysfunction in elderly patients using liquid chromatography and Q-TOF mass spectrometry[J]. Oxid Med Cell Longev, 2020, 2020: 8957541. [8] CULLEY D J, FLAHERTY D, FAHEY M C, et al. Poor performance on a preoperative cognitive screening test predicts postoperative complications in older orthopedic surgical patients[J]. Anesthesiology, 2017, 127(5): 765-774. [9] ZHOU Y, FENG H, LI G, et al. Efficacy of computerized cognitive training on improving cognitive functions of stroke patients: a systematic review and meta-analysis of randomized controlled trials[J]. Int J Nurs Pract, 2022, 28(3): e12966. [10] BUTZ M, GERRIETS T, SAMMER G, et al. Effects of postoperative cognitive training on neurocognitive decline after heart surgery: a randomized clinical trial[J]. Eur J Cardiothorac Surg, 2022, 62(5): ezac251. [11] PAN C, ZHANG H, ZHANG L, et al. Surgery-induced gut microbial dysbiosis promotes cognitive impairment via regulation of intestinal function and the metabolite palmitic amide[J]. Microbiome, 2023, 11(1): 248. [12] JIANG X L, GU X Y, ZHOU X X, et al. Intestinal dysbacteriosis mediates the reference memory deficit induced by anaesthesia/surgery in aged mice[J]. Brain Behav Immun, 2019, 80: 605-615. [13] WANG P, YIN X, CHEN G, et al. Perioperative probiotic treatment decreased the incidence of postoperative cognitive impairment in elderly patients following non-cardiac surgery: a randomised double-blind and placebo-controlled trial[J]. Clin Nutr, 2021, 40(1): 64-71. [14] NI P, DONG H, ZHOU Q, et al. Preoperative sleep disturbance exaggerates surgery-induced neuroinflammation and neuronal damage in aged mice[J]. Mediators Inflamm, 2019, 2019: 8301725. [15] XING F, FANG X, GONG X D, et al. Photoacoustic treatment mitigates cognitive dysfunction in a model of sleep-wake rhythm disturbance[J]. Neural Regen Res, 2020, 15(6): 1094-1101. [16] SONG J, CHU S, CUI Y, et al. Circadian rhythm resynchronization improved isoflurane-induced cognitive dysfunction in aged mice[J]. Exp Neurol, 2018, 306: 45-54. [17] FAN Y, YUAN L, JI M, et al. The effect of melatonin on early postoperative cognitive decline in elderly patients undergoing hip arthroplasty: a randomized controlled trial[J]. J Clin Anesth, 2017, 39: 77-81. [18] LIU Y, CHU J M T, RAN Y, et al. Prehabilitative resistance exercise reduces neuroinflammation and improves mitochondrial health in aged mice with perioperative neurocognitive disorders[J]. J Neuroinflammation, 2022, 19(1): 150. [19] DUAN S, LIAO Y, TANG Y, et al. Short-term perioperative cognitive therapy combined with rehabilitation exercise reduces the incidence of neurocognitive disorder in elderly patients: a randomized controlled trial[J]. Minerva Anestesiol, 2022, 88(3): 145-155. [20] LIANG C K, CHU C S, HSU Y H, et al. Effects of modified version of the Hospital Elder Life Program on post-discharge cognitive function and activities of daily living among older adults undergoing total knee arthroplasty[J]. Arch Gerontol Geriatr, 2021, 93: 104284. [21] PUNJASAWADWONG Y, CHAU-IN W, LAOPAIBOON M, et al. Processed electroencephalogram and evoked potential techniques for amelioration of postoperative delirium and cognitive dysfunction following non-cardiac and non-neurosurgical procedures in adults[J]. Cochrane Database Syst Rev, 2018, 5(5): Cd011283. [22] MOMENI M, MEYER S, DOCQUIER M A, et al. Predicting postoperative delirium and postoperative cognitive decline with combined intraoperative electroencephalogram monitoring and cerebral near-infrared spectroscopy in patients undergoing cardiac interventions[J]. J Clin Monit Comput, 2019, 33(6): 999-1009. [23] UYSAL S, LIN H M, TRINH M, et al. Optimizing cerebral oxygenation in cardiac surgery: a randomized controlled trial examining neurocognitive and perioperative outcomes[J]. J Thorac Cardiovasc Surg, 2020, 159(3): 943-953.e3. [24] GLUMAC S, KARDUM G, SODIC L, et al. Longitudinal assessment of preoperative dexamethasone administration on cognitive function after cardiac surgery: a 4-year follow-up of a randomized controlled trial[J]. BMC Anesthesiol, 2021, 21(1): 129. [25] MU D L, ZHANG D Z, WANG D X, et al. Parecoxib supplementation to morphine analgesia decreases incidence of delirium in elderly patients after hip or knee replacement surgery: a randomized controlled trial[J]. Anesth Analg, 2017, 124(6): 1992-2000. [26] LIANG J, HAN S, YE C, et al. Minocycline attenuates sevoflurane-induced postoperative cognitive dysfunction in aged mice by suppressing hippocampal apoptosis and the notch signaling pathway-mediated neuroinflammation[J]. Brain Sci, 2023, 13(3):512. [27] TAKAZAWA T, HORIUCHI T, ORIHARA M, et al. Prevention of postoperative cognitive dysfunction by minocycline in elderly patients after total knee arthroplasty: a randomized, double-blind, placebo-controlled clinical trial[J]. Anesthesiology, 2023, 138(2): 172-183. [28] CHEN H, LI F. Effect of dexmedetomidine with different anesthetic dosage on neurocognitive function in elderly patients after operation based on neural network model[J]. World Neurosurg, 2020, 138: 688-695. [29] DEINER S, LUO X, LIN H M, et al. Intraoperative infusion of dexmedetomidine for prevention of postoperative delirium and cognitive dysfunction in elderly patients undergoing major elective noncardiac surgery: a randomized clinical trial[J]. JAMA Surg, 2017, 152(8): e171505. [30] ZHANG M, ZHANG Y H, FU H Q, et al. Ulinastatin may significantly improve postoperative cognitive function of elderly patients undergoing spinal surgery by reducing the translocation of lipopolysaccharide and systemic inflammation[J]. Front Pharmacol, 2018, 9: 1007. [31] CHO I, KOO B N, KIM S Y, et al. Neuroprotective effect of dexmedetomidine against postoperative cognitive decline via nlrp3 inflammasome signaling pathway[J]. Int J Mol Sci, 2022, 23(15): 8806. [32] YANG Y, WEI C, LIU J, et al. Atorvastatin protects against postoperative neurocognitive disorder via a peroxisome proliferator-activated receptor-gamma signaling pathway in mice[J]. J Int Med Res, 2020, 48(5): 300060520924251. [33] GONG M, WANG G, LI G, et al. Dysfunction of inflammation-resolving pathways is associated with postoperative cognitive decline in elderly mice[J]. Behav Brain Res, 2020, 386: 112538. [34] CHEN Q, LEI Y Q, LIU J F, et al. Triptolide improves neurobehavioral functions, inflammation, and oxidative stress in rats under deep hypothermic circulatory arrest[J]. Aging (Albany N Y), 2021, 13(2): 3031-3044. [35] WEI P, JIA M, KONG X, et al. Human umbilical cord-derived mesenchymal stem cells ameliorate perioperative neurocognitive disorder by inhibiting inflammatory responses and activating BDNF/TrkB/CREB signaling pathway in aged mice[J]. Stem Cell Res Ther, 2023, 14(1): 263. [36] SUN L, YONG Y, WEI P, et al. Electroacupuncture ameliorates postoperative cognitive dysfunction and associated neuroinflammation via NLRP3 signal inhibition in aged mice[J]. CNS Neurosci Ther, 2022, 28(3): 390-400. [37] TATTI E, ROSSI S, INNOCENTI I, et al. Non-invasive brain stimulation of the aging brain: State of the art and future perspectives[J]. Ageing Res Rev, 2016, 29: 66-89. [38] WANG Q, LIU T, CHANG H, et al. Low-intensity pulsed ultrasound attenuates postoperative neurocognitive impairment and salvages hippocampal synaptogenesis in aged mice[J]. Brain Sci, 2023, 13(4): 657. |
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