老年病人的术后认知功能障碍

Postoperative cognitive dysfunction in elderly patients

术后认知功能障碍(POCD)定义为术后通过反复多次神经心理测试,患者的基本认知功能出现不同程度的损害。而早期术后认知功能及精神障碍更多见于老年患者。虽然POCD多见于心脏手术术后,但非心脏手术后发生POCD亦不少见,老年患者(年龄大于65岁)行心脏手术或非心脏手术,术后1周POCD的发生率分别为50%及26%。POCD的高危因素包括:高龄、术前认知受损以及酗酒等。POCD影响生活质量,加重社会负担并干扰药物治疗效果,延长患者住院周期。有必要深入的研究POCD的病因和神经功能保护的策略。

Postoperative cognitive dysfunction is defined on the basis of change in cognitive function detected with repeated assessments using neuropsychological tests. Early postoperative cognitive dysfunction and acute confusional states are common after major surgery in the elderly. Although postoperative cognitive dysfunction （POCD） is most frequent after cardiac surgery, the prevalence of POCD after noncardiac surgery in older patients is also significant. The high incidence of POCD after cardiac and non-cardiac surgery in the elderly is approximately 50% and 26%, respectively, one week after surgery. The risk factors for POCD include advanced age, preexisting cognitive impairment, alcohol abuse, and so on. POCD is likely to impair quality of life and constitutes a large burden on society and interfere with therapeutics of drug and increase length of hospital stay. Because of the magnitude of the clinical problem, serious consideration must be directed toward understanding its etiology and the development of neuroprotective strategies. The purpose of this review was to discuss recent development in our understanding of the pathophysiologic mechanisms, prevention, and treatments.