Studies on postoperative neurological complications, particularly cognitive dysfunction.
Studies on postoperative neurological complications, particularly cognitive dysfunction.
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术后神经并发症，特别是认知功能障碍的研究。
DOI：
10.1007/s00540-013-1674-9
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Saito S.
中科院分区：
文献类型：
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作者：
Ogino Yuichi;Kakeda T;Nakamura K;Saito S.;Saito S.
术后呼吸和循环并发症越来越多地被先进的医疗技术成功地处理。然而，中枢神经系统(CNS)并发症的预防并不成功。这一趋势在发达国家似乎更为明显，在这些国家，大多数接受手术的患者都是患有并存疾病的老年人。例如，据报道，在术后早期，超过一半的患者出现了体外循环(CPB)后的神经心理功能障碍[1]。许多关于这一主题的原创报道和综述文章都发表在这本杂志上。特别是，心脏和骨科手术后的认知功能障碍经常被讨论。脑梗塞可能是致命的，也可能导致严重残疾。因此，该并发症是术后最严重的中枢神经系统并发症。然而，幸运的是，严重病例的发生率并不是很高，据报道，在一项对大型队列的分析中，总体中风发生率约为1-2%[1，2]。然而，大手术后轻微神经系统并发症的发生率相当高，认知功能障碍远比中风更为常见[2]。虽然这些被归类为“临床上的小并发症”，但它们能够干扰患者术后的生活。报道的大手术后认知功能障碍的发生率差异很大[1，2]。在术后即刻，发病率高达80%-90%，这意味着几乎所有的患者在大手术后都会经历认知异常。然而，在手术后几个月，发病率下降到不到一半的患者，在手术后一年进一步下降到大约四分之一。尽管大多数早期认知丧失可能是真的，但多项纵向研究表明，在某些情况下，手术后，尤其是心脏手术后，这种情况会持续数年[3]。持久的神经症状的发生率似乎不容忽视。轻微的神经损伤，如认知功能障碍，并不一定会增加中风后卧床不起的患者数量。然而，与中风相比，极高的发病率使得这些伤害在社会影响方面非常成问题，例如老年人的生活质量和对医疗资源的经济负担。
Postoperative respiratory and circulatory complications are increasingly successfully managed by advanced medical technologies. However, prevention of central nervous system (CNS) complications is not as successful. This trend seems to be more apparent in developed countries, where most patients undergoing surgeries are elderly people with coexisting diseases. For example, neuropsychological dysfunction after cardiopulmonary bypass (CPB) has been reported in more than half of patients during the early postoperative period [1]. Many original reports and review articles regarding this topic have been published in this journal. In particular, cognitive dysfunctions following cardiac and orthopedic surgery are often discussed. Cerebral infarction can be fatal or can cause severe disabilities. Hence, this complication is the most serious central neurological complication after surgery. Fortunately, however, the incidence of severe cases is not very high, the overall stroke rate in an analysis of large cohorts reportedly being approximately 1–2%[1, 2]. However, the incidence of minor neurological complications following major surgeries is quite high, with cognitive dysfunction being far more common than stroke [2]. Although these are categorized as ‘‘clinically minor complications,’’they are capable of interfering with the life of patients postoperatively.There is wide variation among the reported rate of cognitive dysfunction after major surgery [1, 2]. In the immediate postoperative period, the incidence ranges as high as 80–90%, which means that almost all patients experience cognitive abnormalities after major surgery. However, at several months after the surgery, the incidence decreases to less than half of the patients, further decreasing to around one-fourth of patients at 1 year after the surgery. Although it may be true that most of the early cognitive loss is transient, multiple longitudinal studies demonstrated that, in some cases, it persists for several years after surgery, especially after cardiac surgery [3]. The incidence of long-lasting neurological symptoms seems not to be negligible. Minor neurological injuries, such as cognitive dysfunctions, do not necessarily increase the number of bedridden patients as seen after stroke. However, the extremely high incidence compared to stroke makes these injuries extremely problematic, in terms of the social impact, such as quality of life of an aged population and economic burden on healthcare resources.