围术期认知功能评估
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Perioperative cognitive evaluation
本文回顾了2017年1月至2018年6月期间最新发表的与围手期认知评估功能有关的临床研究，对其危险因素、预防、诊断和诊断工具及治疗的新见解进行综述。
已发现几种危险因素（术前、术中和术后）与术后谵妄（POD）和/或术后认知功能障碍（POCD）的发展有关。针对危险因素，引入预防策略和频繁的认知功能监测，可以减少短期和长期的术后临床结局。氯胺酮、阿片类药物和苯二氮卓类药物的使用与认知功能障碍的增加有关。对POD/POCD采取预防措施有助于恢复术前状态，这包括：频繁的认知功能监测、获得康复和心理学及社会的支持以及避免多种药物治疗。此外，患者应尽早获得帮助，并保持正常的昼夜节律。POD/POCD的治疗包含了药理学和非药理学方法。
POD/POCD的临床研究不断发展，这对指导临床管理及临床护理至关重要。
原始文献摘要
Borozdina Anastasia ， Qeva Ega ， Cinicola Marco
Perioperative cognitive evaluation ；Current Opinion in Anaesthesiology； doi:10.1097/ACO.0000000000000658
Purpose of review
This article reviews the recent clinical evidence published between January 2017 and June 2018 – related to perioperative cognitive evaluation. Namely, new insights into risk factors, prevention, diagnosis and diagnostic tools and treatment.
Recent findings
Several risk factors (preoperative, intraoperative and postoperative) have been found to be associated with the development of postoperative delirium (POD) and/or postoperative cognitive dysfunction (POCD). Short-term and long-term postoperative consequences can be reduced by targeting risk factors, introducing
preventive strategies and including frequent cognitive monitoring. Administration of medications such as ketamine, opioids and benzodiazepines are associated with increased cognitive dysfunction. Prevention of POD/POCD starts with creating an environment, which promotes return to preoperative baseline functioning. This includes frequent monitoring of cognitive status, access to rehabilitation and psychological and social supports, and avoiding polypharmacy. In addition, patients should have early access to their sensory aids and maintain normal circadian rhythm. Treatment of POD/POCD has pharmacological and nonpharmacological approaches.
Summary
Clinical evidence on POD/POCD is continuously evolving, which is essential in guiding clinical management to provide the highest quality of clinical care.
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