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摘要譯文

老年人術後認知功能障礙的研究現狀

術後認知功能障礙（POCD）是指手術後數週至數月內發生的一種長期認知功能障礙。它在老年人中特別普遍，導致發病率和死亡率增加。隨著麻醉和外科護理的不斷改善和越來越安全，如今有越來越多的老年患者進行擇期外科手術，但隨著他們經歷圍手術期，POCD的風險也在增加。POCD的病理生理學研究仍在進行中，目前研究認為POCD的主要可能的發病機制包括麻醉方式、麻醉劑的使用、腦灌注不足、過度通氣和神經炎症。這些發現揭示了認識到易發生POCD的高危患者（包括老年人）的重要性，並採取預防措施，包括術前和術後認知測試、麻醉期間的仔細監測，血壓控制和術後併發症的早期治療。在這篇綜述中，我們提供了對導致POCD的病理生理學的最新瞭解，特別是針對老年人群確定其危險因素，預防和治療策略。

關鍵詞：

衰老；麻醉；虛弱；老年醫學；術後認知功能障礙；術後譫妄

原文摘要

Current Perspectives on Postoperative Cognitive Dysfunction in the Ageing Population.

Postoperative cognitive dysfunction (POCD) is defined as a prolonged cognitive function impairment that occurs within weeks to months of a surgical procedure. It is especially prevalent in the elderly population, leading to increased morbidity and mortality. As anaesthetic and surgical care continues to improve and become increasingly safer, a significantly greater number of older patients have elective surgical procedures today, yet this comes with an increased POCD risk as they go through the perioperative phases. Although the pathophysiology behind the development of POCD is still under investigation, current causative mechanisms include the mode of anaesthesia administered, anaesthetic used, cerebral hypoperfusion, hyperventilation and neuroinflammation. These findings lend an insight into the importance of being cognisant of the higher likelihood of POCD in at-risk patients, including the elderly, and taking precautions to include preoperative and postoperative cognitive testing, careful monitoring during anaesthesia, blood pressure control and early treatment of postoperative complications as they arise. In this review, we provide an update on the current understanding of the pathophysiology leading to POCD, identifying risk factors, prevention and treatment strategies, with a specific focus on the elderly population.

KEYWORDS:

Ageing; anaesthesia; frailty; geriatrics; postoperative cognitive dysfunction; postoperative delirium

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關鍵字: 術後 功能障礙 手術兩百年

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