Peri-operative neurocognitive disorders(PNDs)include postoperative delirium(POD)and postoperative cognitive dysfunction(POCD).Children and the elderly are the two populations most vulnerable to the development of POD ...Peri-operative neurocognitive disorders(PNDs)include postoperative delirium(POD)and postoperative cognitive dysfunction(POCD).Children and the elderly are the two populations most vulnerable to the development of POD and POCD,which results in both high morbidity and mortality.There are many factors,including neuroinflammation and oxidative stress,that are associated with POD and POCD.General anesthesia is a major risk factor of PNDs.However,the molecular mechanisms of PNDs are poorly understood.Dexmedetomidine(DEX)is a useful sedative agent with analgesic properties,which significantly improves POCD in elderly patients.In this review,the current understanding of anesthesia in PNDs and the protective effects of DEX are summarized,and the underlying mechanisms are further discussed.展开更多
基金the grants from the National Natural Science Foundation of China to WS(82150710557,82293642).
文摘Peri-operative neurocognitive disorders(PNDs)include postoperative delirium(POD)and postoperative cognitive dysfunction(POCD).Children and the elderly are the two populations most vulnerable to the development of POD and POCD,which results in both high morbidity and mortality.There are many factors,including neuroinflammation and oxidative stress,that are associated with POD and POCD.General anesthesia is a major risk factor of PNDs.However,the molecular mechanisms of PNDs are poorly understood.Dexmedetomidine(DEX)is a useful sedative agent with analgesic properties,which significantly improves POCD in elderly patients.In this review,the current understanding of anesthesia in PNDs and the protective effects of DEX are summarized,and the underlying mechanisms are further discussed.
文摘目的：评价全凭静脉靶控输注麻醉不同的镇静深度对妇科腹腔镜术后认知功能的影响。方法择期妇科腹腔镜手术患者90例，年龄18～60岁，BMI 19～30 kg/m2，ASAⅠ或Ⅱ级。采用随机数字表法，将患者分为3组，每组30例。术中采用丙泊酚和瑞芬太尼靶控输注（TCI），间断静脉注射罗库溴铵维持麻醉，调控瑞芬太尼和丙泊酚血药浓度维持BIS值水平，Ⅰ组：30＜BIS值≤40，Ⅱ组：40＜BIS值≤50，Ⅲ组：50＜BIS值≤60。麻醉前1 d及术后1 d，记录简易精神状态量表（MMSE）评分及连线试验（TMT）完成时间。结果3组患者麻醉前1 d和术后1 d MMSE评分均＞24分，组内及组间比较差异均无统计学意义（P〉0.05）。与麻醉前1 d相比，Ⅰ组和Ⅱ组患者术后1 d TMT完成时间缩短，Ⅲ组延长（P﹤0.05）；其中Ⅱ组和Ⅲ组术后1 d时TMT完成时间差异无统计学意义（P〉0.05），与Ⅱ组和Ⅲ组比较，Ⅰ组术后1 d TMT完成时间显著缩短（P﹤0.05）。结论全凭静脉靶控输注丙泊酚-瑞芬太尼，麻醉维持30＜BIS值≤40镇静深度对妇科腹腔镜术后认知功能影响较小。
