术后脑功能障碍与麻醉.pptVIP

 病例一 女性病人 76岁，在全身麻醉下行直肠癌根治术，术前无特殊，能骑自行车。术后出现严重的精神障碍, 表现为反应迟钝，呆滞和少言等，曾请神经内科和麻醉科会诊，头颅CT提示有陈旧性腔梗。2 月后症状有所缓解，以后缺乏随访。 病例二 女性，75岁，因左股骨颈骨折，在硬膜外麻醉下行股骨头置换术，术后病人出现妄想，自言多语和幻觉失语等，曾请精神科会诊。一周后恢复。 1、发生了什么？ 2、为什么会发生与新近的研究？ 3、预防措施与麻醉管理？ 一、发生了什么？ Adverse Cerebral Effects of Anesthesia on Old People Review of records of 1193 patients: Age 50 years or older Operation under GA Mental deterioration in 120 (10%) patients Conclusions Cognitive decline related to anesthetic agents and hypotension “Operations on elderly people should be confined to unequivocally necessary cases” Poor Memory Common After Surgery NEW YORK (Reuters) – If youve ever felt fuzzy or out of sorts after having general anesthesia, youre not alone. A study suggests that as many as one out of four people over age 60 have problems with memory, concentration, and other intellectual skills after surgery, a cluster of problems known as cognitive dysfunction. The problem can persist for weeks or months, according to a report in The Lancet… 1998 术后谵妄 Postoperative Delirium （PD） 术后认知功能障碍 Postoperative Cognitive Disorders （POCD） 术后谵妄（PD） 临床表现特点是以注意力紊乱，对周围环境的认知度减低为主要症状的精神状态的改变。它起病急，持续数小时至数天，病情起伏波动，伴随不能集中注意力等认知障碍综合征（如迷惘、一系列记忆功能障碍）、感知能力紊乱、幻觉及睡眠周期紊乱等。 术后认知功能障碍（POCD） POCD是一个与手术相关的认知恶化，评价这些表现形式多样的POCD有赖于有效的术前术后认知功能的评价、精神心理的测试。 International study Postoperative Cognitive Dysfunction ISPOCD ?  ISPOCD-1 was an international study on postoperative cognitive dysfunction (POCD), i.e. problems with memory, learning and the ability to concentrate emerging after surgery.The follow-up study, ISPOCD-2, is the ongoing quest for investigating etiological, pathophysiological and epidemiological aspects of POCD.  International Study of POCD Incidence of POCD in Patients and Controls:Patients 60 y.o. 一项前瞻性的研究评价年龄与POCD的关系 Single site - University of Florida: 1999 - 2002 1200 patients undergoing elective surgery