Umholtz Matthew, Nader Nader D
a Department of Anesthesiology , Brandon Regional Hospital , Tampa , FL.
b Anesthesiology and Surgery, University at Buffalo , Buffalo , NY.
Immunol Invest. 2017 Nov;46(8):805-815. doi: 10.1080/08820139.2017.1373898.
Postoperative delirium and cognitive dysfunction are phenomena that are associated with increases in morbidity, mortality, and resource utilization after surgery. This review scrutinized a number of studies in order to better characterize the biochemical basis for associated cognitive dysfunction and delirium, with particular focus paid to the interactions of the cholinergic system with innate immunity and how the modulation of the immune system contributes to associated neuroinflammation. Despite the clinical impact of postoperative cognitive dysfunction, evidence-based protocols for the prevention and treatment of these disorders are still lacking. Several previous trials have attempted to prevent or treat clinical manifestation by modulation of the cholinergic system with acetylcholinesterase inhibitors, the results of which have been largely ambiguous at best. As the biochemical basis of postoperative cognitive dysfunction becomes more clearly defined, future research into therapeutics based on immune modulation and treatment of neuroinflammation may prove to be very promising.
术后谵妄和认知功能障碍是与术后发病率、死亡率增加以及资源利用相关的现象。本综述仔细研究了多项研究，以便更好地描述相关认知功能障碍和谵妄的生化基础，特别关注胆碱能系统与先天免疫的相互作用，以及免疫系统的调节如何导致相关的神经炎症。尽管术后认知功能障碍具有临床影响，但仍缺乏基于证据的预防和治疗这些疾病的方案。此前有几项试验试图通过使用乙酰胆碱酯酶抑制剂调节胆碱能系统来预防或治疗临床表现，其结果充其量大多不明确。随着术后认知功能障碍的生化基础变得更加明确，未来基于免疫调节和神经炎症治疗的疗法研究可能会被证明非常有前景。
