Rigshospitalet, Section of Surgical Pathophysiology, The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen O, Denmark.
Best Pract Res Clin Anaesthesiol. 2012 Sep;26(3):345-53. doi: 10.1016/j.bpa.2012.07.004.
Postoperative delirium (PD) and postoperative cognitive dysfunction (POCD) are two separate syndromes of cognitive decline after major surgery, especially in the elderly. Pathogenesis is multifactorial with some common risk factors, and to reduce the risk, a multimodal approach is necessary. The fast-track methodology is becoming a well-established perioperative care regime with possible preventive effects for postoperative cognitive decline, including reduced pain and use of opioids, and early mobilisation with early discharge (≤3 days) to preoperative environment after total hip/knee arthroplasty (THA/TKA). The fast-track set-up seems to be associated with a lower frequency of PD and early POCD after THA/TKA. Thus, in a series of 225 patients ≥60 years, no cases of PD were seen and the incidence of POCD was reduced by more than 50% at 1 week postoperatively compared to previous studies. In conclusion, the fast-track methodology may reduce the incidence of postoperative cognitive decline after surgery.
术后谵妄（PD）和术后认知功能障碍（POCD）是大手术后认知能力下降的两种独立综合征，尤其是在老年人中。发病机制是多因素的，有一些共同的危险因素，为了降低风险，需要采取多模式方法。快速康复方法已成为一种成熟的围手术期护理方案，可能对术后认知能力下降具有预防作用，包括减少疼痛和阿片类药物的使用，以及在全髋关节/膝关节置换术（THA/TKA）后尽早（≤3 天）回到术前环境进行早期活动。快速康复方案似乎与 THA/TKA 后 PD 和早期 POCD 的发生率较低有关。因此，在一项 225 例年龄≥60 岁的患者系列研究中，与以往研究相比，1 周后 PD 发生率为零，POCD 发生率降低了 50%以上。总之，快速康复方法可能会降低手术后认知能力下降的发生率。
