术后认知功能障碍炎症相关机制及其防治

Inflammation-relevant mechanisms for postoperative cognitive dysfunction and the preventive strategy

术后认知功能障碍(postoperative cognitive dysfunction,POCD)是一种轻度的认知功能紊乱,是指术前无认知障碍的患者在麻醉手术后出现精神活动、人格、社交活动及认知能力的改变。记忆减退是认知功能障碍患者的核心症状及表现,年龄是术后长期认知功能损害的主要危险因素。POCD的发生将延长患者的住院时间,降低患者的生存质量,增加术后死亡率,给个人和社会造成严重负担。如何有效地预防、干预POCD的发生发展,减少不良后果,是手术患者(尤其是老年患者)围手术期亟需解决的问题。虽然POCD的病理生理机制仍然不明,但目前倾向于认为炎症在POCD中扮演重要作用。无菌手术诱导外周炎症反应,通过相关途径传入中枢,因个体差异,导致了不同严重程度的中枢炎症反应,进而引起POCD。因此,针对POCD的防治方法也应着重围绕减轻炎症反应展开。

Postoperative cognitive dysfunction （POCD） is thought to be a mild cognitive disorder. It means that patients without cognitive diseases before surgery suff er from subtle changes in psychomotility, personality, social skills and cognitive function aft er the surgery. A decline in memory is the core characteristics of these symptoms. POCD is mainly seen in the elderly people following surgery. It can prolong hospital stay, reduce quality of life, increase mortality, and thus aggravate the burden of public health. It is urgent to take precautions to reduce the incidence. Th e precise mechanism of POCD remains unclear. Previous studies have shown that infl ammation plays an important role in it. Sterile surgery can result in peripheral infl ammation. Th rough several pathways, the signals from the peripheral immune response were sent to central system. Due to the individual diff erence, the degree of the central neuroinflammation was also heterogeneous. Some inflammations may lead to the occurrence of POCD. In order to prevent POCD, we should focus on the anti-inflammatory therapy.