Department of Gynecology, Obstetrics and Reproduction Medicine, Saarland University, Homburg, Germany.
Department of Anesthesia and Intensive Care, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy.
Int J Gynaecol Obstet. 2024 Sep;166(3):954-968. doi: 10.1002/ijgo.15464. Epub 2024 Apr 1.
Despite their general good health, an increasing proportion of elderly individuals require surgery due to an increase in average lifespan. However, because of their increased vulnerability, these patients need to be handled carefully to make sure that surgery does not cause more harm than good. Age-related postoperative cognitive disorders (POCD) and postoperative delirium (POD), two serious consequences that are marked by adverse neuropsychologic alterations after surgery, are particularly dangerous for the elderly. In the context of gynecologic procedures, POCD and POD are examined in this narrative review. The main question is how to limit the rates of POCD and POD in older women undergoing gynecologic procedures by maximizing the risk-benefit balance. Three crucial endpoints are considered: (1) surgical procedures to lower the rates of POCD and POD, (2) anesthetic techniques to lessen the occurrence and (3) the identification of individuals at high risk for post-surgery cognitive impairments. Risks associated with laparoscopic gynecologic procedures include the Trendelenburg posture and CO exposure during pneumoperitoneum, despite statistical similarities in POD and POCD frequency between laparoscopic and laparotomy techniques. Numerous risk factors are associated with surgical interventions, such as blood loss, length of operation, and position holding, all of which reduce the chance of complications when they are minimized. In order to emphasize the essential role that anesthesia and surgery play in patient care, anesthesiologists are vital in making sure that anesthesia is given as sparingly and quickly as feasible. In addition, people who are genetically predisposed to POCD may be more susceptible to the disorder. The significance of a thorough strategy combining surgical and anesthetic concerns is highlighted in this article, in order to maximize results for senior patients having gynecologic surgery.
尽管老年人总体健康状况良好，但由于平均寿命的延长，越来越多的老年人需要接受手术。然而，由于他们的脆弱性增加，这些患者需要小心处理，以确保手术不会弊大于利。与年龄相关的术后认知障碍（POCD）和术后谵妄（POD）是手术后出现的两种严重后果，它们对老年人尤其危险。在妇科手术中，本文对 POCD 和 POD 进行了叙述性综述。主要问题是如何通过最大限度地平衡风险和收益来降低接受妇科手术的老年女性的 POCD 和 POD 发生率。考虑了三个关键终点：（1）降低 POCD 和 POD 发生率的手术程序，（2）减轻发生的麻醉技术，以及（3）识别术后认知障碍风险较高的个体。与妇科腹腔镜手术相关的风险包括头高脚低位和二氧化碳暴露于气腹期间，尽管腹腔镜和剖腹手术技术之间 POD 和 POCD 频率存在统计学相似性。许多手术相关的风险因素，如失血、手术时间和体位保持，都会降低并发症的发生几率，这些因素都应尽量减少。为了强调麻醉和手术在患者护理中的重要作用，麻醉师在确保麻醉尽可能地节省和快速实施方面发挥着至关重要的作用。此外，那些遗传上易患 POCD 的人可能更容易患该疾病。本文强调了结合手术和麻醉问题的综合策略的重要性，以最大限度地提高接受妇科手术的老年患者的治疗效果。
