Luo Li, Gong Qihai, He Miao, Zhu Yuhang, Yu Wanqiu, Gong Taowu, Zhao Pengcheng, Zhu Zhaoqiong
Anesthesia Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
Anesthesia Department, Suining Central Hospital, Suining, Sichuan, China.
Front Nutr. 2025 Aug 13;12:1601021. doi: 10.3389/fnut.2025.1601021. eCollection 2025.
This literature review examines the relationship between malnutrition and perioperative neurocognitive disorders (PND), which encompass cognitive impairments occurring throughout the perioperative period, including pre-existing cognitive impairments, postoperative delirium, delayed neurocognitive recovery, and postoperative cognitive dysfunction. Malnutrition is associated with an increased incidence of PND, affecting patient recovery and quality of life. Studies suggest that preoperative malnutrition may heighten the risk of PND, and that preoperative nutritional diagnosis and perioperative nutritional interventions could reduce the occurrence of PND. The review discusses the definition, diagnosis, and indicators of malnutrition, as well as the mechanisms by which malnutrition leads to PND, including direct pathways such as psychological factors, abnormal neurotransmitter synthesis, and changes in brain structure and function, and indirect pathways like impaired immune function, neuroinflammation, mitochondrial dysfunction, intestinal barrier damage, disruption of the gut-brain axis, lymphatic system dysfunction, and endocrine disruption. Finally, this paper summarizes the existing nutritional intervention strategies for improving PND, explores the research directions of malnutrition and PND, and emphasizes that future research needs to clarify the role of nutritional intervention in specific populations and conduct in-depth studies on the molecular mechanisms of nutritional intervention and PND prevention.
这篇文献综述探讨了营养不良与围手术期神经认知障碍（PND）之间的关系，围手术期神经认知障碍包括在整个围手术期发生的认知障碍，包括术前已存在的认知障碍、术后谵妄、延迟性神经认知恢复和术后认知功能障碍。营养不良与围手术期神经认知障碍的发生率增加相关，影响患者的恢复和生活质量。研究表明，术前营养不良可能会增加围手术期神经认知障碍的风险，术前营养诊断和围手术期营养干预可以减少围手术期神经认知障碍的发生。该综述讨论了营养不良的定义、诊断和指标，以及营养不良导致围手术期神经认知障碍的机制，包括心理因素、神经递质合成异常以及脑结构和功能变化等直接途径，以及免疫功能受损、神经炎症、线粒体功能障碍、肠屏障损伤、肠脑轴破坏、淋巴系统功能障碍和内分泌紊乱等间接途径。最后，本文总结了现有的改善围手术期神经认知障碍的营养干预策略，探讨了营养不良和围手术期神经认知障碍的研究方向，并强调未来的研究需要阐明营养干预在特定人群中的作用，并对营养干预和预防围手术期神经认知障碍的分子机制进行深入研究。
