Clancy Olivia, Edginton Trudi, Casarin Annalisa, Vizcaychipi Marcela P
Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK.
Imperial College Faculty of Medicine, London, UK.
J Intensive Care Soc. 2015 Aug;16(3):226-233. doi: 10.1177/1751143715569637. Epub 2015 Jan 26.
Mortality rates alone are no longer a sufficient guide to quality of care. Due to medical advances, patients are surviving for longer following critical illness and major surgery; therefore, functional outcomes and long-term quality of life are of increasing consequence. Post-operative cognitive dysfunction has been acknowledged as a complication following anaesthesia for many years, and interest in persistent cognitive dysfunction following a critical illness is growing. Psychological and neurocognitive sequelae following discharge from intensive care are acknowledged to occur with sufficient significance to have recently coined the term 'the post-intensive care syndrome'. Rehabilitation following critical illness has been highlighted as an important goal in recently published national UK guidelines, including the need to focus on both physical and non-physical recovery. Neuropsychological and cognitive consequences following anaesthesia and critical illness are significant. The exact pathophysiological mechanisms linking delirium, cognitive dysfunction and neuropsychological symptoms following critical illness are not fully elucidated but have been studied elsewhere and are outside the scope of this article. There is limited evidence as yet for specific peri-operative preventative strategies, but early management and rehabilitation strategies following intensive care discharge are now emerging. This article aims to summarise the issues and appraise current options for management, including both neuroprotective and neurorehabilitative strategies in intensive care.
仅死亡率已不再足以作为医疗质量的指导。由于医学进步，危重病和大手术后患者存活的时间更长；因此，功能转归和长期生活质量的重要性日益凸显。术后认知功能障碍多年来一直被认为是麻醉后的一种并发症，对危重病后持续性认知功能障碍的关注也在增加。重症监护病房出院后的心理和神经认知后遗症被认为具有足够的显著性，以至于最近创造了“重症监护后综合征”这一术语。危重病后的康复已被列为英国最近发布的国家指南中的一个重要目标，包括需要关注身体和非身体方面的恢复。麻醉和危重病后的神经心理和认知后果很显著。危重病后谵妄、认知功能障碍和神经心理症状之间的确切病理生理机制尚未完全阐明，但已在其他地方进行了研究，不在本文讨论范围内。目前关于围手术期具体预防策略的证据有限，但重症监护病房出院后的早期管理和康复策略正在出现。本文旨在总结相关问题并评估当前的管理选择，包括重症监护中的神经保护和神经康复策略。
