Department of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Department of Anesthesiology, Xiangyang Maternal and Child Health Hospital, Xiangyang, 441003, China.
Eur J Pharmacol. 2024 May 15;971:176520. doi: 10.1016/j.ejphar.2024.176520. Epub 2024 Mar 23.
Postoperative cognitive dysfunction (POCD) is a common complication following surgery, adversely impacting patients' recovery, increasing the risk of negative outcomes, prolonged hospitalization, and higher mortality rates. The N-methyl-D-aspartate (NMDA) receptor, crucial for learning, memory, and synaptic plasticity, plays a significant role in the development of POCD. Various perioperative factors, including age and anesthetic use, can reduce NMDA receptor function, while surgical stress, inflammation, and pain may lead to its excessive activation. This review consolidates preclinical and clinical research to explore the intricate relationship between perioperative factors affecting NMDA receptor functionality and the onset of POCD. It discusses the influence of aging, anesthetic administration, perioperative injury, pain, and inflammation on the NMDA receptor-related pathophysiology of POCD. The comprehensive analysis presented aims to identify effective treatment targets for POCD, contributing to the improvement of patient outcomes post-surgery.
术后认知功能障碍（POCD）是手术后常见的并发症，会对患者的康复产生不利影响，增加不良结局、住院时间延长和死亡率升高的风险。N-甲基-D-天冬氨酸（NMDA）受体对学习、记忆和突触可塑性至关重要，在 POCD 的发展中起重要作用。各种围手术期因素，包括年龄和麻醉药物的使用，会降低 NMDA 受体功能，而手术应激、炎症和疼痛可能导致其过度激活。本综述整合了临床前和临床研究，以探讨围手术期影响 NMDA 受体功能的因素与 POCD 发病之间的复杂关系。它讨论了衰老、麻醉管理、围手术期损伤、疼痛和炎症对与 NMDA 受体相关的 POCD 病理生理学的影响。所呈现的综合分析旨在确定 POCD 的有效治疗靶点，以改善术后患者的预后。
