术后神经认知障碍:临床指南
Ozlem Korkmaz Dilmen1, Basak Ceyda Meco2, Lisbeth A Evered3
1Istanbul University- Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Anaesthesiology and Intensive Care, Istanbul, Turkey.
Journal of clinical anesthesia
|November 9, 2023
概括
手术后的认知功能障碍可能会对患者产生负面影响,尤其是老年人. 在安全大脑倡议的指导下,实施一系列预防措施,可以减少其发生率和持续时间.
科学领域:
- 麻醉学 麻醉学
- 神经科学是一个神经科学.
- 老年病的医生 老年病的医生
背景情况:
- 手术后的认知结果越来越令人担忧,影响患者的自主权,生活质量,并增加患病/死亡率,特别是在老年患者中.
- 手术和麻醉压力可以引发神经炎症,神经毒性和高凝血病,导致认知能力下降.
- 缓解外科手术期间压力的多方面的策略在改善患者的治疗结果方面表现有前途.
研究的目的:
- 为预防,诊断和治疗术后神经认知障碍提出基于证据的建议.
- 在患者护理中倡导安全大脑倡议的方法.
- 突出一个整体的,以团队为基础的战略的重要性.
主要方法:
- 对术后认知结果的经验研究的审查.
- 分析涉及认知功能障碍的病理生理过程.
- 检查预防策略,包括EEG导向麻醉,止痛和血液动力学稳定性.
- 考虑ESAIC安全大脑倡议的建议.
主要成果:
- 多方面的预防措施 (手术前,手术内,手术后) 可以减少手术后妄想的发生率和持续时间.
- 个性化麻醉深度,足够的镇痛和血液动力稳定性是可修改的危险因素.
- 基于团队的方法提高了临床和功能结果.
结论:
- 建议在以患者为中心的护理中实施一组非侵入性预防措施.
- 证据支持综合策略在缓解术后神经认知障碍方面的有效性.
- 安全大脑倡议为改善患者护理和治疗结果提供了一个框架.
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