Ancelin M L, De Roquefeuil G, Ritchie K
INSERM EPI-9930 "Pathologies du Système Nerveux: Recherche Epidémiologique et Clinique", CRLC Val d'Aurelle, Bat Rech. Rdc, Parc Euromédecine, 34298 Montpellier Cedex 5.
Rev Epidemiol Sante Publique. 2000 Oct;48(5):459-72.
Amnesic effects of anesthesia were first reported two hundred years ago, but the term postoperative cognitive dysfunction (POCD) has appeared only recently, covering a larger range of neuropsychological modifications resulting from surgical intervention. The clinical description of POCD is highly variable, ranging from concentration impairment to delirium. Significant short-term POCD is common in elderly persons, and can persist several months, varying both in time and intensity and affecting the full-range of cognitive functions (visual and auditory attention, primary and secondary memory, implicit memory, and visuospatial functioning). Incidence rates vary widely according to surgery type but also between studies for a given surgical procedure, as a result of methodological difficulties and limitations. Variability is largely attributable to the absence of a standardized POCD definition, the heterogeneity of procedures to measure cognitive deficits and the methods used for statistical analyses, but is also related to the disparity in targeted populations. The wide variation in study design and target populations precludes the application of formal meta-analysis procedures. We review the definition, epidemiology, etiology, pathophysiology and the clinical and public health implications of POCD. The effects of anesthetics are described in relation to ageing-related physiological changes. It is concluded that the complex interaction of etiological factors makes it difficult to determine at this point of time to what extent POCD may be attributed specifically to anesthetic agents.
麻醉的遗忘作用早在两百年前就有报道，但术后认知功能障碍（POCD）这一术语最近才出现，它涵盖了手术干预导致的更广泛的神经心理学改变。POCD的临床描述差异很大，从注意力受损到谵妄不等。严重的短期POCD在老年人中很常见，可能持续数月，在时间和强度上都有所不同，并影响全方位的认知功能（视觉和听觉注意力、初级和次级记忆、内隐记忆以及视觉空间功能）。发病率因手术类型而异，而且由于方法上的困难和局限性，对于给定的手术程序，不同研究之间也存在差异。这种变异性很大程度上归因于缺乏标准化的POCD定义、测量认知缺陷的程序的异质性以及统计分析所使用的方法，但也与目标人群的差异有关。研究设计和目标人群的广泛差异使得无法应用正式的荟萃分析程序。我们综述了POCD的定义、流行病学、病因、病理生理学以及临床和公共卫生意义。还描述了麻醉剂的作用与衰老相关生理变化的关系。得出的结论是，病因因素的复杂相互作用使得目前难以确定POCD在多大程度上可能具体归因于麻醉剂。
