炎症反应与术后认知功能并发症的关系研究进展.pdfVIP

Med J Chin PLA, Vol. 39, No. 8, August 1, 2014 　673 炎症反应与术后认知功能并发症的关系研究进展 李雅巍，王东信 [摘要]　认知功能并发症(包括谵妄及认知功能障碍)是一种老年患者术后常见的并发症，且其发生常伴随着预后 的恶化。术后认知功能并发症的发生机制目前尚不完全清楚，但已有研究表明中枢神经系统炎症反应可能在其中发挥 重要作用。外周炎症反应可通过多种途径引发中枢神经系统炎症反应，而后者可以干扰神经元功能、抑制神经元的再 生并诱导其凋亡，最终导致认知功能的损害和并发症发生。术中单次应用大剂量糖皮质激素、围术期复合使用非甾体 抗炎药可能有助于减少术后认知功能并发症的发生。围术期预防性应用乌司他丁及麻醉方式的选择在预防术后认知功 能并发症中的作用值得进一步研究。 [关键词]　炎症；中枢神经系统；手术后并发症；认知障碍；谵妄 [中图分类号]　R619.9　　　　[文献标志码]　A　　　　[文章编号]　0577-7402(2014)08-0673-05 [DOI]　10.11855/j.issn.0577-7402.2014.08.17 Relationship between inflammatory response and postoperative cognitive complications: Advance in research * LI Ya-wei, WANG Dong-xin Department of A nesthesiology, First Hospital of Peking University, Beijing 100034, China * Corresponding author, E-mail: wangdongxin@ [Abstract]　Postoperative cognitive complications (including delirium and cognitive dysfunction) are common in elderly patients after an operation, and they are usually accompanied by a poor prognosis. Although the mechanism of postoperative cognitive complications remains unclear, previous studies suggest that inflammatory reaction of central neural system (CNS) may play an important role in its development. Peripheral inflammatory reaction could be spread to CNS in several ways, and inflammatory reaction of CNS may interfere its function, inhibit the regeneration of neurons, and induce apoptosis of neurons, finally resulting in cognitive impairment and complications. Intraoperative administration of single, high-dose glucocorticoid (dexamethasone) and perioperative non-steroidal anti-inflammatory drugs (NSAIDs) may be helpful to decrease the incidence of postoperative cognitive complications. The influence of perioperative prophylactic usage of ulin