围手术期神经认知功能障碍的现状与未来

Status and future of perioperative neurocognitive disorders

摘要:

围手术期神经认知功能障碍（perioperative neurocognitive disorders， PND）是一种常见的手术麻醉并发症，以记忆、注意力、语言理解和社交能力的损伤为特征，可导致患者生活质量下降，延长住院周期、增加病死率。PND发病率高，对患者术后恢复及生活质量影响大，给社会及家庭造成沉重的经济负担，近年来成为重要的公共卫生问题。高龄是PND主要的高危因素，因此，对PND研究已成为老年性疾病的研究热点之一。PND可能与麻醉、手术及患者本身等多因素相关，但其发病机制尚不明确。由于缺乏明确的定义和有效的诊断测试方法，PND的临床研究长期陷入困境。手术前后准确评估神经认知功能和识别危险因素对于明确PND的诊断、寻找与麻醉和手术相关的任何因果关系是非常重要的。但迄今为止，还没有单独的麻醉技术、药物或监测模式被证明能够降低PND的发生率。本文概述了近年来PND的多项研究，为发生PND高风险的患者提供相关的预防建议。

Abstract:

Perioperative neurocognitive disorders(PND） is an important complication of surgical anesthesia, characterized by impairment of memory, attention, language comprehension and social ability, which can lead to decreased quality of life, prolonged hospital stay, and increased mortality. Due to high incidence, it has a great impact on postoperative recovery and quality of life of patients; it also can cause heavy economic burden to the society and families, and become an important public health problem. Advanced age is a major risk factor for PND, so the study of PND has become one of the research hotspots of senile diseases. The occurrence of PND may be related to multiple factors such as anesthesia, surgery and patients themselves, but its pathogenesis is still unclear. There is lack of a clear definition and effective diagnostic test, the clinical study of PND seems to be more complex. Preoperative evaluation of neurocognitive function and risk factor identification is important to determine the true extent of PND and to look for any causal relationship associated with anesthesia and surgery, but to date, no single anesthesia technique, drug, or monitoring pattern has been shown to reduce the incidence of PND. This article summarizes studies on PND in recent years and provides relevant prevention recommendations for patients at high risk of PND.