Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China.
Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China.
Exp Gerontol. 2020 Feb;130:110791. doi: 10.1016/j.exger.2019.110791. Epub 2019 Nov 23.
Postoperative cognitive dysfunction (POCD) is a common disorder following surgery, which seriously threatens the quality of patients' life, especially the older people. Accumulating attention has been paid to POCD worldwide in pace with the popularization of anesthesia/surgery. The development of medical humanities and rehabilitation medicine sets higher demands on accurate diagnosis and safe treatment system of POCD. Although the research on POCD is in full swing, underlying pathogenesis is still inconclusive due to these conflicting results and controversial evidence. Generally, POCD is closely related to neuropsychiatric diseases such as dementia, depression and Alzheimer's disease in molecular pathways. Researchers have come up with various hypotheses to reveal the mechanisms of POCD, including neuroinflammation, oxidative stress, autophagy disorder, impaired synaptic function, lacking neurotrophic support, etc. Recent work focused on molecular mechanism of POCD in older people has been thoroughly reviewed and summed up here, concerning the changes of peripheral circulation, pathological pathways of central nervous system (CNS), the microbiota-gut-brain axis and the related brain regions. Accordingly, this article provides a better perspective to understand the development situation of POCD in older people, which is conductive to uncover the pathological mechanism and exploit reasonable treatment strategy of POCD.
术后认知功能障碍（POCD）是手术后常见的一种障碍，严重威胁着患者的生活质量，尤其是老年人。随着麻醉/手术的普及，全世界对 POCD 的关注度日益提高。医学人文和康复医学的发展对 POCD 的准确诊断和安全治疗体系提出了更高的要求。尽管对 POCD 的研究如火如荼，但由于这些相互矛盾的结果和有争议的证据，其发病机制仍不清楚。一般来说，POCD 在分子途径上与痴呆、抑郁症和阿尔茨海默病等神经精神疾病密切相关。研究人员提出了各种假设来揭示 POCD 的机制，包括神经炎症、氧化应激、自噬障碍、突触功能障碍、缺乏神经营养支持等。本文对近年来关于老年人 POCD 分子机制的研究进行了综述，包括外周循环的变化、中枢神经系统（CNS）的病理途径、微生物群-肠道-大脑轴及相关脑区，旨在为理解老年人 POCD 的发展状况提供更好的视角，有助于揭示其病理机制，探索合理的 POCD 治疗策略。
