术中静脉输注利多卡因对老年患者全麻下非心脏手术后认知功能的影响

认知功能障碍是术后常见的中枢神经系统功能障碍,表现为记忆力、计算能力和抽象概括能力减退.语言障碍、视空间功能障碍、失认和失用等[1].高龄是术后认知功能障碍的危险因素[2].     

术中静脉输注利多卡因对老年患者全麻下非心脏手术后认知功能的影响

认知功能障碍是术后常见的中枢神经系统功能障碍,表现为记忆力、计算能力和抽象概括能力减退.语言障碍、视空间功能障碍、失认和失用等[1].高龄是术后认知功能障碍的危险因素[2].     

术中静脉输注利多卡因对老年患者全麻下非心脏手术后认知功能的影响

认知功能障碍是术后常见的中枢神经系统功能障碍,表现为记忆力、计算能力和抽象概括能力减退.语言障碍、视空间功能障碍、失认和失用等[1].高龄是术后认知功能障碍的危险因素[2].     

术中静脉输注利多卡因对老年患者全麻下非心脏手术后认知功能的影响

认知功能障碍是术后常见的中枢神经系统功能障碍,表现为记忆力、计算能力和抽象概括能力减退.语言障碍、视空间功能障碍、失认和失用等[1].高龄是术后认知功能障碍的危险因素[2].     

术中静脉输注利多卡因对老年患者全麻下非心脏手术后认知功能的影响

认知功能障碍是术后常见的中枢神经系统功能障碍,表现为记忆力、计算能力和抽象概括能力减退.语言障碍、视空间功能障碍、失认和失用等[1].高龄是术后认知功能障碍的危险因素[2].     

术中静脉输注利多卡因对老年患者全麻下非心脏手术后认知功能的影响

认知功能障碍是术后常见的中枢神经系统功能障碍,表现为记忆力、计算能力和抽象概括能力减退.语言障碍、视空间功能障碍、失认和失用等[1].高龄是术后认知功能障碍的危险因素[2].     

术中静脉输注利多卡因对老年患者全麻下非心脏手术后认知功能的影响

认知功能障碍是术后常见的中枢神经系统功能障碍,表现为记忆力、计算能力和抽象概括能力减退.语言障碍、视空间功能障碍、失认和失用等[1].高龄是术后认知功能障碍的危险因素[2].     

术中静脉输注利多卡因对老年患者全麻下非心脏手术后认知功能的影响

认知功能障碍是术后常见的中枢神经系统功能障碍,表现为记忆力、计算能力和抽象概括能力减退.语言障碍、视空间功能障碍、失认和失用等[1].高龄是术后认知功能障碍的危险因素[2].     

术中静脉输注利多卡因对老年患者全麻下非心脏手术后认知功能的影响

认知功能障碍是术后常见的中枢神经系统功能障碍,表现为记忆力、计算能力和抽象概括能力减退.语言障碍、视空间功能障碍、失认和失用等[1].高龄是术后认知功能障碍的危险因素[2].     

术中静脉输注利多卡因对老年患者全麻下非心脏手术后认知功能的影响

认知功能障碍是术后常见的中枢神经系统功能障碍,表现为记忆力、计算能力和抽象概括能力减退.语言障碍、视空间功能障碍、失认和失用等[1].高龄是术后认知功能障碍的危险因素[2].     

Pathophysiology of post-operative cognitive dysfunction: current hypotheses

Post-operative cognitive dysfunction (POCD) has been reported after a variety of surgical procedures. POCD is associated with a decline in performance of activities of daily living of elderly patients and can cause substantial damage to family and/or to social support systems. The incidence of POCD in the first week after surgery is 23% in patients between 60 and 69 years of age and 29% in patients older than 70. Cognitive dysfunction was still present in 14% of patients over 70 at three month after surgery. The risk of POCD increases with age, and the type of surgery is also important since there is very low incidence of POCD after minor surgery. For many years, it has been known that general anaesthesia is associated with persistent changes in gene expression in the brain for at least 72 hours. These observed modifications suggest an interesting hypothesis to explain the side effects of anaesthetic agents on cognitive dysfunction, particularly in the elderly. The inflammatory response to surgery is consistent with the hypothesis that inflammation contributes to cognitive decline in the elderly. Most of the drugs administered during anaesthesia interact with the cerebral cholinergic system, which seems to be impaired with ageing. One can hypothesize that this cholinergic dysfunction is a potent factor in the pathogenesis of POCD. These findings have implications for the information provided before obtaining consent from elderly patients prior to surgery; a careful evaluation of mental status is mandatory for all elderly patients undergoing general anaesthesia. Perioperative physicians should be familiar with the prevention, diagnosis, and management of postoperative cognitive dysfunction.     

Postoperative cognitive dysfunction: incidence and prevention

Postoperative cognitive dysfunction (POCD) is a decline in cognitive function for weeks or months after surgery. Due to its subtle nature, neuropsychological testing is necessary for its detection. The interpretation of literature on POCD is difficult because of numerous methodological limitations, particularly the different definitions of POCD and the lack of data from control groups. POCD is common after cardiac surgery, and recent studies have now verified that POCD also exists after major non-cardiac surgery, although at a lower incidence. The risk of POCD increases with age, and the type of surgery is also important because there is a very low incidence associated with minor surgery. Regional anaesthesia does not seem to reduce the incidence of POCD, and cognitive function does not seem to improve after carotid surgery as has previously been suggested.     

Measurement of post‐operative cognitive dysfunction after cardiac surgery: a systematic review

Post‐operative cognitive dysfunction (POCD) is a decline in cognitive function from pre‐operative levels, which has been frequently described after cardiac surgery. The purpose of this study was to examine the variability in the measurement and definitions for POCD using the framework of a 1995 Consensus Statement on measurement of POCD. Electronic medical literature databases were searched for the intersection of the search terms ‘thoracic surgery’ and ‘cognition, dementia, and neuropsychological test.’ Abstracts were reviewed independently by two reviewers. English articles with >50 participants published since 1995 that performed pre‐operative and post‐operative psychometric testing in patients undergoing cardiac surgery were reviewed. Data relevant to the measurement and definition of POCD were abstracted and compared with the recommendations of the Consensus Statement. Sixty‐two studies of POCD in patients undergoing cardiac surgery were identified. Of these studies, the recommended neuropsychological tests were carried out in less than half of the studies. The cognitive domains measured most frequently were attention (n=56; 93%) and memory (n=57; 95%); motor skills were measured less frequently (n=36; 60%). Additionally, less than half of the studies examined anxiety and depression, performed neurological exam, or accounted for learning. Four definitions of POCD emerged: per cent decline (n=15), standard deviation decline (n=14), factor analysis (n=13), and analysis of performance on individual tests (n=12). There is marked variability in the measurement and definition of POCD. This heterogeneity may impede progress by reducing the ability to compare studies on the causes and treatment of POCD.     

NLRP3 inflammasomes are involved in the progression of postoperative cognitive dysfunction: from mechanism to treatment

Neurosurgical Review - Postoperative cognitive dysfunction (POCD) involves patient memory and learning decline after surgery. POCD not only presents challenges for postoperative nursing and...     

Postoperative cognitive dysfunction. Possible neuronal mechanisms and practical consequences for clinical routine

Postoperative cognitive dysfunction (POCD) presents as a long-lasting decline in cognitive function after a surgical procedure, predominantly occurring in elderly patients. The causes are most likely multifactorial with the exact mechanisms still unknown. Hypotheses of the causes of POCD are based on experimental evidence that anesthetics can impair mechanisms of learning and memory on a neuronal level and might lead to neurodegeneration. Additionally, surgery can result in neuroinflammation which could also underlie POCD. The most important strategy to avoid POCD is to maintain the patient's physiological homeostasis perioperatively. According to the presently available clinical studies recommendations in favor or against certain anesthesiological procedures cannot be given.     

Postoperative Cognitive Dysfunction after Total Joint Arthroplasty in the Elderly: A Meta-Analysis

This meta-analysis consolidated the research on postoperative cognitive dysfunction (POCD) following total joint arthroplasty (TJA). Data from 17 studies that assessed cognition pre- and post-surgery in TJA patients alone (15 studies) or matched TJA and control groups (2 studies) were analysed. Results were grouped by cognitive domain (memory, attention, language, speed, general cognition) and follow-up interval (pre-discharge, 3-6 months post-surgery). The TJA data revealed small declines in reaction time and general cognition pre-discharge, but no evidence of decline 3–6 months post-surgery. Very limited TJA and Control data indicated no group differences in the changes to performance over time; however, the TJA group was cognitively compromised pre- and post-surgery compared to Controls. Further appropriately controlled research is required to clarify whether POCD commonly occurs after TJA.     

高压氧处理对患者术后认知功能障碍的影响

背景 术后认知功能障碍(postoperative cognitive dysfunction,POCD)指的是患者手术麻醉后出现的认知功能减退,往往产生长久的严重后果,尤其是老年患者.高压氧(hyperbaric oxygen,HBO)处理作为一项辅助治疗措施目前已广泛应用于临床,大量研究证实HBO处理对大脑、心脏及肝等多种器官具有保护作用.已有研究者将HBO处理运用到认知功能障碍的研究中. 目的 探讨HBO处理对患者POCD的影响及其作用机制,为改善老年患者手术后认知功能及长期预后提供有效措施. 内容 对HBO处理、HBO处理用于POCD的研究情况及HBO改善POCD的作用机制进行综述. 趋向 HBO处理是近年来用于多脏器保护的重要措施,其脑保护作用为临床预防及改善POCD提供了新的思路.     

Postoperative cognitive dysfunction after noncardiac surgery: a systematic review

This article describes a systematic review on the research into postoperative cognitive dysfunction (POCD) in noncardiac surgery to ascertain the status of the evidence and to examine the methodologies used in studies. The review demonstrated that in the early weeks after major noncardiac surgery, a significant proportion of people show POCD, with the elderly being more at risk. Minimal evidence was found that patients continue to show POCD up to 6 months and beyond. Studies on regional versus general anesthesia have not found differences in POCD. Many studies were found to be underpowered, and a number of other methodologic difficulties were identified. These include the different types of surgery in studies and variations in the number and range of neuropsychological tests used. A particular issue is the variety of definitions used to classify individuals as having POCD.     

硝普钠控制性降压对老年全髋置换术后认知功能的影响

Objestive To investigate the effects of nitroprusside induced hypotension on cognitive function after total hip replacement and the serum S-100 level in reflecting postoperative cognitive dysfunction （POCD）. Methods Forty patients （age 〉65 yr） undergoing total hip replacement were assigned to two groups, randomly, in one group, the mean arterial pressure was decreased about 30% by sodium nitroprusside. In another group, the MAP was set constant as control. Serum values of S-100 were determined preoperatively and 0 2 h and 24 h postoperatively. Neuropsychological tests （Mini-Mental State Examination MMSE） for detecting POCD were performed preoperatively and the 4^th day after the operation. A decline of more than 2 scores in MMSE results was regarded as POCD. Results According to our definition, 7 patients had POCD. There were no significant differeeces in MMSE test in two groups （P 〉0.05）. Those patients had POCD showed higher serum concentrations of S-100 than those without POCD, especially at 0.2 h postoperatively （P 〈0. 05）. Conclusion Nitroprusside induced hypotension would no/impair cognitive function in old patients after total hip arthroplasty. S-100 appears to be suitable in the assessment or incidence of cognitive dysfunctioas postoperatively.     

Toll样受体4在术后认知功能障碍中作用机制的研究进展

术后认知功能障碍（POCD）是由多种因素引起的麻醉和手术后认知功能减退,持续时间可达数周、数月甚至更长,对高危人群早期筛查和干预能够明显改善围术期POCD患者的转归。Toll样受体4（TLR4）是目前研究最多的免疫炎性模式识别受体,在多种类型的中枢神经细胞中表达并对神经认知发挥调控作用。在POCD发生过程中,TLR4可通过参与炎症反应、调控神经发生、激发氧化应激以及微生物-肠-脑轴等多种途径调控其进展。本文对TLR4的结构和功能和TLR4参与POCD进展的可能作用机制进行综述。