术后神经认知功能恢复延迟评估与管理的循证分析  

Evidence‑based analysis of evaluation and management of delayed recovery of neurocognitive function after surgery

作　　者：汤灵宇 陈顺利 黄厚强 郑思琳 Tang Lingyu;Chen Shunli;Huang Houqiang;Zheng Silin(Operating Room,Affiliated Hospital of Southwest Medical University,Luzhou 646000,China;Department of Pediatrics,Affiliated Hospital of Southwest Medical University,Luzhou 646000,China;Department of Nursing,Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院手术室,泸州646000 [2]西南医科大学附属医院儿科,泸州646000 [3]西南医科大学附属医院护理部,泸州646000

出　　处：《国际麻醉学与复苏杂志》2024年第12期1277-1283,共7页International Journal of Anesthesiology and Resuscitation

基　　金：西南医科大学校级课题自科青年项目(2022QN034)。

摘　　要：目的总结术后神经认知功能恢复延迟(DNCR)管理的最佳证据,为DNCR的防治提供参考。方法计算机检索2018年1月至2023年10月BMJ Best Practice、Up To Date、JBI循证卫生保健中心(JBI)、OVID、国家指南协作网(GIN)、英国国家卫生与临床优化研究所(NICE)、苏格兰院际指南网(SIGN)、美国麻醉医师协会(ASA)、欧洲麻醉医师协会(ESAIC)、全球脑健康学会(GCBH)、PubMed、Web of Science核心合集数据库、中国知网(CNKI)、维普资讯(VIP)、中国生物医学文献数据库、万方数据、医脉通指南网、中华医学会麻醉学分会官网内关于DNCR评估与管理的证据,包括指南、专家共识、临床决策、系统评价。由2名研究者进行文献质量评价和资料提取。结果共纳入13篇文献,包括1篇指南、9篇专家共识、1篇临床决策、2篇系统评价。最终在风险因素筛查、认知评估、麻醉优化及药物审查、疼痛管理、器官供给与需求反馈监测管理、抗应激管理、认知支持治疗、多学科团队合作、教育培训9个方面形成了29条最佳证据。结论为DNCR的管理提供了循证依据,临床人员在使用时应结合临床实际,遵循个体化原则,联合多学科团队实施多模式多维度围手术期管理。Objective To summarize the best evidence for managing delayed neurocognitive recovery(DNCR)after surgery and provide reference for the prevention and treatment of DNCR.Methods Retrieved BMJ Best Practice,Up To Date,Joanna Briggs Institute(JBI),OVID,Guidelines International Network(GIN),the National Institute for Health and Care Excellence(NICE),the Scot⁃tish Intercollegiate Guidelines Network(SIGN),the American Society of Anesthesiologists(ASA),the European Society of Anesthesiolo⁃gy and Intensive Care(ESAIC),the Global Council on Brain Health(GCBH),PubMed,the Database of Web of Science Core Collection,China National Knowledge Infrastructure(CNKI),China Science and Technology Journal Database(VIP),Chinese Biomedical Litera⁃ture Database,Wanfang Database,Yimai Tong Guideline Network,and the Chinese Society of Anesthesiology website from January 2018 to October 2023 for evidence on DNCR assessment and management,including guidelines,expert consensus,clinical decisions,and systematic reviews.Two researchers evaluated the quality of the literature and extracted relevant data.Results A total of 13 doc⁃uments were included,comprising 1 guideline,9 expert consensus statements,1 clinical decision,and 2 systematic reviews.There were 29 optimal evidence recommendations across nine areas:risk factor screening,cognitive assessment,anesthesia optimization and medi⁃cation review,pain management,monitoring of organ supply and demand feedback,stress management,cognitive support therapy,multi⁃disciplinary team collaboration,and education and training.Conclusions This study provides evidence⁃based guidance for manag⁃ing DNCR.Clinical personnel should tailor these recommendations to clinical realities,adhere to individualized principles,and imple⁃ment multimodal and multidimensional perioperative management with multidisciplinary team collaboration.

关 键 词：术后神经认知功能恢复延迟 术后神经认知障碍 循证医学 

分 类 号：R47[医药卫生—护理学]