认知储备与围手术期神经认知障碍

Cognitive reserve and perioperative neurocognitive disorders

围手术期神经认知障碍(perioperative neurocognitive disorders,PND)是指与麻醉和手术相关的神经认知改变,主要包括术后谵妄(postoperative delirium,POD)和术后认知功能障碍(postoperative cognitive dysfunction,POCD),是围手术期最常见的神经系统并发症之一,至今无有效的治疗和预防手段。减少术后认知不良的发生和促进术后认知功能的恢复是当代麻醉的重点。越来越多的研究认为可以将认知储备作为术后认知不良发生的预防手段。文章介绍认知储备的作用机制和PND的病理生理机制,结合国外研究阐述认知储备对认知功能产生作用的机制,概述认知储备与PND的相关性,分析认知储备在预防PND方面的有效性,为临床预防PND提供参考。

Perioperative neurocognitive disorders(PND)that including postoperative delirium(POD)and postoperative cogni⁃tive dysfunction(POCD)is one of the most common neurological complications during the perioperative period,and there is no effective treatment or prevention.To reduce postoperative cognitive impairment and promote the recovery of postoperative cognitive function is the focus of contemporary anesthesia.More and more studies suggest that cognitive reserve can be used as a preventive measure for postoperative cognitive impairment.This review will introduce the mechanism of action of cognitive reserve and the pathophysiological mechanism of PND,combined with foreign studies to elaborate the mechanism of cognitive reserve's effect on cognitive function,sum⁃marize the correlation between cognitive reserve and PND,analyze the effectiveness of cognitive reserve in preventing PND,and pro⁃vide a reference for clinical prevention of PND.