From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Psychology, Temple University, Philadelphia, Pennsylvania.
Anesth Analg. 2021 Jun 1;132(6):1502-1513. doi: 10.1213/ANE.0000000000005525.
Postoperative cognitive dysfunction (POCD) has been reported with widely varying frequency but appears to be strongly associated with aging. Outside of the surgical arena, chronic and acute cerebral hypoxia may exist as a result of respiratory, cardiovascular, or anemic conditions. Hypoxia has been extensively implicated in cognitive impairment. Furthermore, disease states associated with hypoxia both accompany and progress with aging. Perioperative cerebral hypoxia is likely underdiagnosed, and its contribution to POCD is underappreciated. Herein, we discuss the various disease processes and forms in which hypoxia may contribute to POCD. Furthermore, we outline hypoxia-related mechanisms, such as hypoxia-inducible factor activation, cerebral ischemia, cerebrovascular reserve, excitotoxicity, and neuroinflammation, which may contribute to cognitive impairment and how these mechanisms interact with aging. Finally, we discuss opportunities to prevent and manage POCD related to hypoxia.
术后认知功能障碍（POCD）的报道频率差异很大，但似乎与年龄增长密切相关。在手术领域之外，由于呼吸、心血管或贫血等情况，可能存在慢性和急性脑缺氧。缺氧已被广泛认为与认知障碍有关。此外，与缺氧相关的疾病状态既伴随衰老，也会导致衰老。围手术期脑缺氧可能诊断不足，其对 POCD 的影响也未得到充分认识。在此，我们讨论了各种可能导致 POCD 的疾病过程和形式。此外，我们还概述了与缺氧相关的机制，如缺氧诱导因子的激活、脑缺血、脑血管储备、兴奋性毒性和神经炎症，这些机制可能导致认知障碍，以及这些机制如何与衰老相互作用。最后，我们讨论了预防和管理与缺氧相关的 POCD 的机会。
