刘学胜老髋部骨折术后管理.ppt

- * k * 老年骨科手术POCD发生率 ? Cerebral fat microembolism and cognitive decline after hip and knee replacement. Old patients requiring elective knee or?hip replacement?surgery. A standard neuropsychological test battery was administered before surgery, at hospital discharge and 3 months after surgery POCD incidence: 　75% at discharge 　45% at 3 months Koch S, et al. Stroke 2007; 38(3):1079-81. Newman MF, et al. Lancet 2006; 368: 694–703. 心脏手术术后中枢神经系统并发症 Central nervous system injury associated with cardiac surgery Incidence of POCD in Cardiac Surgery: 50% –70% at discharge (or within the first postoperative week) 30%–50% after 6 weeks 20%–40% at 6 months and 1 year Dokkedal U, et al. Anesthesiology 2016;124(2):312-21. What We Already Know about This Topic A large Danish registry of middle-aged and elderly twins provides a powerful approach to detect subtle effects of surgery and anesthesia on cognitive functioning by minimizing environmental and genetic confounding What This Article Tells Us That Is New In a study of 8,503 twins, a negligible but statistically significant decrease in a sensitive composite cognitive score was present in twins with at least one major surgery, but there was no difference by intrapair analysis There was no clinically significant association of major surgery and anesthesia with long-term cognitive dysfunction, suggesting that factors other than surgery and anesthesia are more important Cognitive Functioning after Surgery in Middle-aged and Elderly Danish Twins Postoperative Cognitive Improvement (POCI) Cormack?F,?et?al.?Neurosci?Biobehav?Rev?2012;?36(9):2118-29. Sauer AM, et al. Ann Thorac Surg 2013; 96: 1294–300 荷兰的Sauer等随机对280例经皮冠状动脉介入治疗及off-pump CABG手术患者，经过长达7.5年的随访研究发现，与非手术组相比，手术组患者术后认知能力提高（Postoperative cognition inprovement, POCI） 什么是POCD？ POCD的定义及诊断极具争议性，一般认为术前无精神障碍的患者，术后发生的一种可逆性、波动性、急性精神紊乱综合征，表现为行为错乱、焦虑、人格改变及记忆受损。但在精神疾病诊断与统计手册中（Diagnostic and Statistical Manual of Mental Disorders，DSM）并没有专门的定义与诊断标准 POCD也没有专门的国际疾病分类（ICD )编