小胶质细胞参与调控术后认知功能障碍的研究进展

背景 术后认知功能障碍（postoperative cognitive dysfunction, POCD）在老年患者中发生率较高。小胶质细胞是一种中枢神经细胞,在中枢神经系统（central nervous system, CNS）生理和病理过程中均发挥重要作用。越来越多的研究表明,小胶质细胞广泛参与神经退行性疾病的发生与发展。 目的 探讨小胶质细胞在POCD中的作用。 内容 简述小胶质细胞对学习记忆的调控作用及其与POCD的相关性。 趋向 小胶质细胞在POCD中的具体作用尚未阐明,继续对此进行深入探究可能为预防和治疗POCD提供新的思路。     

神经炎症对术后认知功能障碍影响的研究进展

术后认知功能障碍（POCD）是手术和麻醉后的常见并发症,老年患者预后较差。POCD表现为注意力、意识、知觉和判断力下降,并时常伴随情绪和人格行为的异常改变,对患者和其家庭有较大的社会和经济影响。POCD相关机制包括中枢神经炎症和外周炎性因子的共同作用,其中神经炎症在POCD的病理生理发展过程中十分重要,然而神经炎症参与POCD发生与发展的机制尚不明确。本文章就神经炎症及其相关研究机制与POCD的关系做一综述,以期为探究POCD的发病机制和寻找新的潜在靶点提供新思路。     

术后认知功能障碍治疗的新靶向-γ-氨基丁酸A型受体相关药物

背景 术后认知功能障碍(postoperative cognitive dysfunction,POCD)是一种常见的围术期并发症.γ-氨基丁酸A型(γ-aminobutyricacid type A,GABAA)受体作为一种中枢神经抑制性受体,可能对POCD的发生起着关键性作用.目的 综述以GABAA受体为靶点的相关药物对POCD的影响.内容 与GABAA受体相关的3类药物:激动剂、拮抗剂和反向激动剂,对POCD可分别产生诱发、逆转和改善症状的作用. 趋向 对记忆或者认知功能损害具有改善作用的GABAA受体相关药物,对POCD的治疗具有重大意义,将成为今后POCD的研究热点.     

神经心理学测试在评价术后认知功能障碍中的应用进展

背景 术后认知功能障碍（postoperative cognitive dysfunction, POCD）是手术后常见的中枢神经系统并发症,但其临床诊断方法缺乏特异性与统一性,诊断POCD的主流方法为神经心理学测试。 目的 对临床诊断POCD的常用神经心理学测试进行综述,为POCD的进一步研究提供参考。 内容 列举并描述临床常用认知功能测试的多个神经心理学量表及其存在的优缺点,介绍国际领先水平POCD研究组的测试组合。 趋向 多种测试方法组合从不同方面评价认知功能取代国内较为单一的评价方法,从而使POCD的临床诊断更加准确。     

Toll样受体4在小胶质细胞炎症反应中的作用与认知功能的关系

概述 小胶质细胞在术后早期中枢炎症反应中担当主角.而Toll样受体4(toll-like receptor 4,TLR4)在小胶质细胞的活化与炎症反应中发挥着不可或缺的作用.中枢炎症细胞因子可通过多种途径影响中枢有关受体或递质功能,从而影响学习记忆和认知能力. 目的 探讨TLR4在小胶质细胞炎症反应中作用及与认知功能的关系. 内容 主要从4个方面进行综述:TLR4与小胶质细胞的关系、小胶质细胞与中枢炎症的关系、炎症和TLR4对认知的影响. 趋向 小胶质细胞在中枢神经系统(central nervous system,CNS)的炎症反应中担当主角.TLR4在小胶质细胞的激活中起关键作用,但TLR4在小胶质细胞相关的中枢炎症反应和认知中的作用尚不清楚.     

术后认知功能障碍的评判方法与评判标准

背景术后认知功能障碍（postoperative cognitive dysfunction,POCD）作为麻醉手术后中枢神经系统的并发症越来越受到重视,由于没有POCD的统一研究方法、严密的定义和诊断标准,POCD的研究结果大相径庭。目的本文回顾了近年来国内外POCD研究中常用评判指标与评判标准,为统一POCD的诊断参数、正确识别POCD提供参考。内容神经心理学方法是目前POCD临床研究中最常使用的方法。但是,神经心理测验最终能否反映认知功能的真实变化还依赖于研究中所选用的神经心理测验的敏感性、重测信度、有无设立对照组、重测的间隔时间以及评判标准等等。趋向尽管国内外已有大量POCD研究报道,但对于最终的防治工作来说,统一POCD的诊断标准具有不可或缺的重要作用。     

神经营养因子对老年人术后认知功能障碍的影响研究

本文综述了术后认知功能障碍（POCD）的定义．发病状况．诊断方法、病因及机制．认为POCD是中枢神经系统衰老的基础上由麻醉和手术诱发的神经功能减退．皮质酮、神经营养因子和神经生长因子都可以引起中枢神经系统的改变,从而导致POCD的发生。研究POCD具有重要的医学、社会和经济意义。     

铁积聚在术后认知功能障碍中的作用

背景术后认知功能障碍（postoperative cognitive dysfunction，POCD）是麻醉手术后常见的神经系统并发症，尤其在老年人多见。脑内铁积聚是一些神经退行性病变的起始因素，通过诱发氧化应激损伤，引起神经元变性坏死。目的探讨铁积聚在POCD中的作用。内容描述脑内铁分布，铁代谢蛋白功能，铁积聚与神经退行性变的关系以及其在POCD中的研究进展。趋向铁积聚可能是引发POCD的重要机制，铁鳌合剂的神经保护作用有望为POCD的治疗提供新思路。     

右美托咪啶对老年患者术后认知功能和围术期单核细胞Toll样受体2和Toll样受体4表达的影响

目的 探讨右美托咪啶对老年患者术后认知功能和围术期单核细胞Toll样受体2(TLR2)和TLR4表达的影响.方法 择期手术治疗的腰椎间盘突出症和腰椎骨折患者45例,年龄≥65岁,体重53～72 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其随机分为3组(n=15):对照组(Ⅰ组)和不同剂量右美托咪啶组(Ⅱ组和Ⅲ组).麻醉诱导结束后静脉输注右美托咪啶负荷剂量1.0μg/kg,输注时间15 min,然后以0.5μg/·kg-1·h-1(Ⅱ组)或1.0 μg·Jg-1·h-1(Ⅲ组)的速率静脉输注至术毕,Ⅰ组给予等容量生理盐水.于麻醉诱导前(T1)、手术开始1.5 h(T2)、术毕(T3)和术后24 h(T4)时取静脉血样,检测外周血单核细胞TLR2及TLR4的表达.分别于术前1d和术后7d时采用简易精神状态量表评分和韦氏成人记忆量表及智力量表评价认知功能,记录术后认知功能障碍的发生情况.结果 与Ⅰ组比较,Ⅱ组和Ⅲ组术后认知功能障碍发生率降低,T2～T4时单核细胞TLR2和TLR4表达下调(P＜0.05);与Ⅱ组比较,Ⅲ组术后认知功能障碍发生率降低,T～T4时单核细胞TLR2和TLR4表达下调(P＜0.05).结论 右美托咪啶可预防老年患者POCD的发生,其机制与抑制单核细胞TLR2和TLR4的表达有关.     

MRI测定海马体积预测老年患者发生术后认知功能障碍的准确性

目的 评价术前MRI测定海马体积预测老年患者发生术后认知功能障碍(POCD)的准确性.方法 拟行胃肠道手术的患者41例,年龄≥65岁,分别于术前和术后4d采用韦氏成人记忆、智力量表中的敏感项目、联线和钉板测试进行神经心理学测试.术后4d借鉴国际术后认知功能障碍研究组织推荐的Z分法评价认知功能,根据是否发生POCD分为POCD组和非POCD组.术前采用MRI测定海马体积,海马体积与Z分间进行直线相关分析,分析海马体积对POED的预测价值.结果 36例老年患者完成本试验,其中13例患者发生了POCD,发生率为36%.POCD组海马体积(4.75 4±0.23)小于非POCD组(5.06±0.31)(P<0.01).海马体积与Z分间呈负相关(r=-0.324,P<0.05).以海马体积预测发生POCD的准确率为77.8%,灵敏度为92.3%,特异度为70.0%,约登指数为0.623.结论 术前采用MRI测定的海马体积可准确地预测老年患者是否发生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.     

Postoperative cognitive decline

Memory loss and lack of concentration are symptoms that frequently occur in patients who have undergone a surgical procedure. Although cognitive function can be assessed using neuropsychological tests, reliable diagnosis of postoperative cognitive decline (POCD) appears to be difficult. Therefore, the true incidence of POCD is unknown. Severe POCD, which is apparent even without neuropsychological testing, is reported most frequently after cardiac and hip-replacement surgery. In these cases, POCD probably reflects microembolic brain injury. Apart from the nature of the surgical procedure, advanced age is the most important risk factor for POCD. The anesthetic technique is not a determinant of POCD: the risk of POCD appears to be similar after both general and regional anesthesia. This review article was invited by the Editorial Board members of the Journal of Anesthesia and was peer-reviewed as were the other articles in this journal.     

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.     

针刺在防治术后认知功能障碍中的机制研究进展

术后认知功能障碍(postoperative cognitive dysfunction,POCD)可导致患者术后发展为痴呆的可能性大大增加,影响患者预后,并增加医疗护理成本和家庭负担。基础研究表明,针刺可通过多重作用机制起到一定的脑保护效应,降低POCD的发生率。文章回顾了近年针刺在POCD领域内的研究进展,综述了可能存在的几种相关机制,包括抑制神经炎症、抑制氧化应激水平、减少神经元损伤、增强突触可塑性以及调节微生物菌群脑-肠轴等。将针刺应用于POCD确实取得了一定的成果,但其作用机制仍未完全明确。随着针刺研究的不断深入,需要尽快明确其作用机制,以便于更好地指导POCD的临床治疗。     

术后认知功能障碍与中枢炎症之间的可能联系

术后认知功能障碍(postoperative cognitive dysfunction,POCD)是一种手术麻醉后新发的认知功能减退,严重影响患者术后生存质量。目前关于POCD的病理生理机制尚不明确,但中枢炎症被认为在其中起重要作用。文章对POCD与中枢炎症可能联系的研究进展进行综述:手术麻醉引起全身系统性炎症反应,炎性因子以直接通过血脑屏障(blood brain barrier,BBB)、破坏BBB或激活多种信号通路等方式引发中枢系统炎症;中枢炎症进一步通过炎症消退迟缓、炎症因子直接作用或非炎性介质间接影响等方式作用于患者的认知功能,从而引发POCD;POCD的风险因素也与中枢炎症密切相关;基于POCD中枢炎症机制的干预措施对POCD预防可能有积极意义。     

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.     

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.     

Is peri‐operative cortisol secretion related to post‐operative cognitive dysfunction?

BACKGROUND: The pattern of cortisol secretion is influenced by surgery. As cortisol can adversely affect neuronal function, this may be an important factor in the development of post-operative cognitive dysfunction (POCD). We hypothesized that the incidence of POCD would be related to changes in cortisol level. METHODS: We studied 187 patients aged over 60 years undergoing major non-cardiac surgery with general or regional anaesthesia. Saliva cortisol levels were measured pre-operatively and at 1 day, 7 days and 3 months post-operatively in the morning (08.00 h) and in the afternoon (16.00 h) using salivettes. Cognitive function was assessed pre-operatively, on day 7 and at 3 months using four neuropsychological tests. POCD was defined as a combined Z score of greater than 1.96. RESULTS: After surgery, salivary cortisol concentrations increased significantly. POCD was detected in 18.8% of subjects at 1 week and in 15.2% after 3 months. The pre-operative ratios between the morning and afternoon cortisol concentrations (am/pm ratios) were 2.8 and 2.7 in patients with POCD at 1 week vs. those without POCD at 1 week, respectively. The am/pm ratios decreased significantly post-operatively to 1.9 and 1.6 at 1 week, respectively (P = 0.02 for both). In an analysis considering all am/pm ratios, it was found that the persistent flattening in am/pm ratio was significantly related to POCD at 1 week. CONCLUSION: The pattern of diurnal variation in cortisol level was significantly related to POCD. Thus, circadian rhythm disturbance or metabolic endocrine stress could be an important mechanism in the development of cognitive dysfunction after major surgery.     

Cognitive function after anaesthesia in the elderly

Despite advances in peri operative care, a significant percentage of elderly patients experience transient post operative delirium and/or long-term post-operative cognitive dysfunction (POCD). This chapter reviews the aetiology, clinical features, preventive strategies and treatment of these syndromes. Pre-operative, intra-operative, and post-operative risk factors for delirium and POCD following cardiac and non-cardiac surgery are discussed. It is most likely that the aetiology of delirium and POCD is multifactorial and may include factors such as age, decreased pre-operative cognitive function, general health status and, possibly, intra-operative events. Currently there is no single therapy that can be recommended for treating post-operative cognitive deterioration. Primary prevention of delirium and POCD is probably the most effective treatment strategy. Several large clinical trials show the effectiveness of multicomponent intervention protocols that are designed to target well-documented risk factors in order to reduce the incidence of post-operative delirium and, possibly, POCD in the elderly.     

术后认知功能障碍发病机制研究进展

背景术后认知功能障碍(postoperative cognitive dysfunction,POCD)是麻醉和术后出现的一种中枢神经系统并发症,其临床表现为认知能力减退、焦虑、记忆受损、语言理解能力和社会融合能力减退等。在老年手术患者中十分常见,可持续数月或数年,甚至发生永久性认知功能障碍,严重影响患者的生活质量,常...