| 金远青,胡杰,王玲.围术期麻醉药物与老年患者术后谵妄相关性的研究进展[J].安徽医药,待发表. |
| 围术期麻醉药物与老年患者术后谵妄相关性的研究进展 |
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| 投稿时间：2026-09-02 录用日期：2026-10-22 |
| DOI： |
| 中文关键词: 老年人 术后谵妄 麻醉药物 围术期脑保护 全身麻醉 |
| 英文关键词: |
| 基金项目:河南省科技发展计划项目(编号:232102310221) |
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| 摘要点击次数: 23 |
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| 中文摘要: |
| 术后谵妄(Postoperative delirium,POD)是老年外科患者围手术期最为常见的中枢神经系统并发症,以急性起病、意识波动、注意力缺损、认知功能紊乱为核心临床特征,显著延长住院时间、增加术后并发症及死亡风险,严重影响远期认知功能与生活质量。POD发病机制复杂,与神经炎症、胆碱能通路紊乱、脑血流异常等密切相关,而围术期麻醉药物作为可干预的关键因素,其与老年患者POD的相关性仍存在诸多争议。随着人口老龄化加剧,老年手术占比逐年攀升,剂量把控、给药模式与POD发生的关联,已经成为麻醉临床与转化研究的热点问题。老年患者因生理机能减退、衰弱状态、基础认知障碍等高危因素叠加,对麻醉药物的代谢与神经耐受度显著下降,围手术期麻醉药物的选择直接影响POD发生风险。本文结合近年国内外循证证据,从全身麻醉药、阿片类镇痛药、肌松及拮抗药、辅助镇静药物等维度梳理各类麻醉药物与老年患者 POD 的相关性,总结发病潜在机制,分析临床争议,阐述围手术期优化麻醉药物策略,同时剖析当前研究局限,对未来临床研究方向进行展望,旨在为老年外科临床麻醉方案个体化制定、降低POD发生率提供循证参考。 |
| 英文摘要: |
| Postoperative delirium (POD) is the most common central nervous system complication in elderly surgical patients during the perioperative period. It is characterized by acute onset, fluctuating consciousness, impaired attention, and cognitive dysfunction. It significantly prolongs hospital stay, increases postoperative complications and mortality risk, and seriously affects long-term cognitive function and quality of life.The pathogenesis of POD is complex and is closely related to neuroinflammation, dysregulation of cholinergic pathways, and abnormal cerebral blood flow. However, the relationship between perioperative anesthetic drugs, which are key factors that can be intervened, and POD in elderly patients remains controversial.With the intensification of population aging, the proportion of surgeries for the elderly has been increasing year by year. The correlation between dosage control, administration mode and the occurrence of POD has become a hot issue in clinical anesthesia and translational research. Due to the combination of high-risk factors such as decreased physiological functions, frailty, and underlying cognitive impairments in elderly patients, their metabolism and neuro-tolerance of anesthetic drugs have significantly decreased. The choice of anesthesia drugs during the perioperative period directly affects the risk of POD occurrence.This article, based on recent domestic and international evidence-based research, examines the correlations between various anesthetic drugs and postoperative delirium (POD) in elderly patients from dimensions such as general anesthetics, opioid analgesics, muscle relaxants and antagonists, and adjunctive sedatives. It summarizes the underlying mechanisms of the disease, analyzes clinical controversies, elaborates on perioperative optimization strategies for anesthetic drugs, and also examines the current research limitations and provides an outlook on future clinical research directions. The aim is to offer evidence-based references for the individualized formulation of clinical anesthesia plans for elderly surgical patients and to reduce the incidence of POD. |
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