Postoperative cognitive dysfunction
Postoperative cognitive dysfunction
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DOI：
10.1093/bja/aei062
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发表时间：
2005-07-01
影响因子：
9.8
通讯作者：
Hanning, CD
中科院分区：
文献类型：
--
作者：
Hanning, CD
麻醉药物的靶器官是大脑。多年来，人们一直认为它们的作用不会超过它们的药理作用，一旦药剂被消除，靶器官就会恢复到以前的状态。越来越多的证据表明，这是不正确的，长期甚至永久性的神经元和神经系统的变化，可以在麻醉药物的管理。大脑在生命的开始和结束时似乎特别脆弱。动物研究表明，永久性的变化可能会引起大脑发育，11 12 23，但这次审查将集中在可能发生的变化，在大脑老化。大脑中神经元损伤的最早表现是高级皮质功能的下降，这些功能包括记忆和认知处理的存储和回忆。日益老龄化的人口刺激了对各种原因导致的过早认知衰退的研究。许多研究调查了术后认知功能障碍（POCD），主要是在老年人中，这些将与因果关系的理论和迄今为止有限的动物工作一起讨论。在这一领域进行人类研究的困难之一是，麻醉几乎从来没有作为一种唯一的程序进行，但几乎总是为了便于手术而进行。如下文所述，对手术的应激反应被认为是POCD的可能机制。因此，在所有人体研究中，术语“手术”应理解为包括麻醉和手术。
The target organ for anaesthetic drugs is the brain. For many years, it has been assumed that their effects do not outlast their pharmacological action, that the target organ is restored to its previous state once the agent is eliminated. There is increasing evidence that this is not true, that long term or even permanent neuronal and neurological change can follow administration of anaesthetic drugs. The brain appears to be particularly vulnerable at the beginning and end of its life. Animal studies have suggested that permanent changes may be induced in developing brains, 11 12 23 but this review will concentrate on changes which may occur in the ageing brain. The earliest manifestation of neuronal damage in the brain is a decline in the higher cortical functions of storage and recall of memory and cognitive processing. The increasingly aged population has stimulated research into premature cognitive decline from all causes. A number of studies have investigated postoperative cognitive dysfunction (POCD), predominantly in the elderly, and these will be discussed together with theories on causation and the limited animal work available thus far. One of the difficulties of human research in this area is that anaesthesia is hardly ever administered as a sole procedure but is almost invariably given to facilitate surgery. As will be discussed below, the stress response to surgery has been suggested as a possible mechanism for POCD. Thus, in all human studies, the term ‘operation’should be understood to include both anaesthesia and surgery.