Krzych Łukasz J, Pluta Michał P, Putowski Zbigniew, Czok Marcelina
Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40752 Katowice, Poland.
Students' Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40752 Katowice, Poland.
J Clin Med. 2020 Sep 30;9(10):3183. doi: 10.3390/jcm9103183.
Postoperative delirium (POD) and postoperative cognitive decline (deficit) (POCD) are related to a higher risk of postoperative complications and long-term disability. Pathophysiology of POD and POCD is complex, elusive and multifactorial. Intraoperative hypotension (IOH) constitutes a frequent and vital health hazard in the perioperative period. Unfortunately, there are no international recommendations in terms of diagnostics and treatment of neurocognitive complications which may arise from hypotension-related hypoperfusion. Therefore, we performed a comprehensive review of the literature evaluating the association between IOH and POD/POCD in the non-cardiac setting. We have concluded that available data are quite inconsistent and there is a paucity of high-quality evidence convincing that IOH is a risk factor for POD/POCD development. Considerable heterogeneity between studies is the major limitation to set up reliable recommendations regarding intraoperative blood pressure management to protect the brain against hypotension-related hypoperfusion. Further well-designed and effectively-performed research is needed to elucidate true impact of intraoperative blood pressure variations on postoperative cognitive functioning.
术后谵妄（POD）和术后认知功能下降（POCD）与术后并发症及长期残疾的较高风险相关。POD和POCD的病理生理学复杂、难以捉摸且具有多因素性。术中低血压（IOH）是围手术期常见且严重的健康危害。遗憾的是，对于由低血压相关低灌注引起的神经认知并发症，在诊断和治疗方面尚无国际推荐。因此，我们对文献进行了全面综述，评估非心脏手术中IOH与POD/POCD之间的关联。我们得出的结论是，现有数据相当不一致，且缺乏令人信服的高质量证据表明IOH是POD/POCD发生的危险因素。研究之间存在相当大的异质性，这是就术中血压管理制定可靠建议以保护大脑免受低血压相关低灌注影响的主要限制。需要进一步设计良好且有效实施的研究来阐明术中血压变化对术后认知功能的真正影响。
