老年衰弱患者围术期神经认知功能障碍诊断及防治研究进展  

Research Progress in Diagnosis,Prevention and Treatment of Perioperative Neurocognitive Disorder in Elderly Frail Patients

作　　者：付泽润 朱志华(综述)[1] 赵国庆(审校)[1] FU Zerun;ZHU Zhihua;ZHAO Guoqing(Department of Anesthesiology,China-Japan Union Hospital of Jilin University,Changchun 130033,China)

机构地区：[1]吉林大学中日联谊医院麻醉科,长春130033

出　　处：《微循环学杂志》2025年第1期89-96,共8页Chinese Journal of Microcirculation

基　　金：吉林省卫生科研人才专项(2024scz24)。

摘　　要：我国老龄化加剧,老年衰弱患者增多。围术期神经认知功能障碍(PND)是常见且严重的并发症,在老年衰弱患者中发病率高,与不良预后密切相关。衰弱与PND相互影响形成恶性循环,其发病机制涉及炎性反应、肌少症、氧化应激等,但尚未完全明确。目前PND诊断方法多样,包括MMSE量表、MoCA量表等测试量表,炎性介质、神经损伤标志物等血清学检验,以及代谢组学技术等,各有优劣且部分尚待完善。在防治方面,术前应利用MMSE量表进行筛查和风险分层,调整基础疾病;麻醉可采用多种复合方式并合理选药;术中要管理麻醉深度、液体及体温;围术期还需做好镇痛与炎症管理。总之,未来需深入研究,精准诊断和防治PND,降低衰弱患者PND发生率,促进其康复与良好预后。The aging population in China is intensifying,and the number of elderly frail patients is increasing.Perioperative neurocognitive disorder(PND)is a common and severe complication,with a high incidence among elderly frail patients and is closely related to poor prognosis.Frailty and PND interact and form a vicious cycle.The pathogenesis involves inflammatory responses,sarcopenia,oxidative stress,etc.,but it has not been fully elucidated.Currently,there are various diagnostic methods for PND,including test scales such as the MMSE scale and MoCA scale,serological tests such as inflammatory mediators and nerve injury markers,and metabolomics techniques,etc.Each has its advantages and disadvantages,and some still need to be improved.In terms of prevention and treatment,preoperative screening and risk stratification should be carried out using the MMSE scale,and underlying diseases should be adjusted.Anesthesia can adopt multiple combined methods and rational drug selection.Intraoperative management of anesthesia depth,fluid,and body temperature is required,and perioperative analgesia and inflammation management also need to be done well.In conclusion,in-depth research is needed in the future to accurately diagnose and prevent PND,reduce the incidence of PND in frail patients,and promote their recovery and good prognosis.

关 键 词：衰弱 围术期神经认知功能障碍 临床诊断 预防 

分 类 号：R459.9[医药卫生—治疗学] R749.16[医药卫生—临床医学]