Rovai Daniele, Giannessi Daniela, Andreassi Maria G, Gentili Claudio, Pingitore Alessandro, Glauber Mattia, Gemignani Angelo
aCNR, Institute of Clinical Physiology bBiomedicine, CNR, Institute of Clinical Physiology cClinical Psychology, Department of Surgery, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa dCardiothoracic Department, Fondazione Toscana G. Monasterio, G. Pasquinucci Heart Hospital, Massa, Italy.
J Cardiovasc Med (Hagerstown). 2015 Dec;16(12):844-51. doi: 10.2459/JCM.0000000000000133.
After cardiac surgery, delirium, cognitive dysfunction, depression, or anxiety disorders frequently occur, and profoundly affect patients' prognosis and quality of life. This narrative review focuses on the main clinical presentations of cognitive and psychological problems ('mind injuries') that occur postoperatively in absence of ascertainable focal neurologic deficits, exploring their pathophysiological mechanisms and possible strategies for prevention and treatment. Postoperative cognitive dysfunction is a potentially devastating complication that can involve several mechanisms and several predisposing, intraoperative, and postoperative risk factors, which can result in or be associated to cerebral microvascular damage. Postoperative depression is influenced by genetic or psychosocial predisposing factors, by neuroendocrine activation, and by the release of several pro-inflammatory factors. The net effect of these changes is neuroinflammation. These complex biochemical alterations, along with an aspecific response to stressful life events, might target the function of several brain areas, which are thought to represent a trigger factor for the onset of depression.
心脏手术后，谵妄、认知功能障碍、抑郁或焦虑症经常发生，并深刻影响患者的预后和生活质量。本叙述性综述重点关注在无明确局灶性神经功能缺损情况下术后出现的认知和心理问题（“脑损伤”）的主要临床表现，探讨其病理生理机制以及可能的预防和治疗策略。术后认知功能障碍是一种潜在的毁灭性并发症，可能涉及多种机制以及多种术前、术中和术后的易感危险因素，这些因素可导致或与脑微血管损伤相关。术后抑郁受遗传或社会心理易感因素、神经内分泌激活以及多种促炎因子释放的影响。这些变化的净效应是神经炎症。这些复杂的生化改变，连同对压力性生活事件的非特异性反应，可能针对几个脑区的功能，而这些脑区被认为是抑郁症发作的触发因素。
