老年患者術(shù)后認(rèn)知功能障礙-課件

老年患者術(shù)后認(rèn)知功能障礙Postoperative?

cognitive?dysfunction?

in?geriatric?patients1ppt課件老年患者術(shù)后認(rèn)知功能障礙Postoperative?

cogDelirium,dementia,andPOCDIncidenceanddiagnosisPotentialmechanismsofPOCDRiskfactorsPreventionandprophylaxisConclusion2ppt課件Delirium,dementia,andPOCD2pPostoperativecognitivedysfunction(POCD)isfrequentlyseenaftersurgicalprocedures.POCDisaseriouscomplicationandischaracterizedbyafunctionaldeclinewhichmaypersistformonths.3ppt課件Postoperativecognitivedysfun術(shù)后認(rèn)知功能障礙（POCD）是外科手術(shù)術(shù)后常見的并發(fā)癥，其特征是持續(xù)數(shù)月的功能下降。尤其是老年患者，其生理上發(fā)生改變，對(duì)于手術(shù)，麻醉及一般住院帶來的壓力的能力減弱，而且老年患者越來越多，POCD更引起人們的關(guān)注。4ppt課件術(shù)后認(rèn)知功能障礙（POCD）是外科手術(shù)術(shù)后常見的并發(fā)癥，其特Delirium,dementia,andPOCDPOCDisoftenconfusedwithdementiaoracutepostoperativedelirium.POCD經(jīng)常與老年癡呆及急性術(shù)后譫妄相混淆。5ppt課件Delirium,dementia,andPOCDPostoperativedeliriumisfrequentlyseenfollowingasurgicalprocedureandhasbeendefinedasanacutechangeinmentalstatus,withinattentionandfluctuatingreducedlevelsofconsciousnessover24h.Themajorityofpostoperativedeliriumcasesoccurbetweendays1and7aftertheoperation.6ppt課件Postoperativedeliriumisf

術(shù)后譫妄是常見于外科手術(shù)后，已被定義為一種急性精神狀態(tài)的改變，表現(xiàn)為注意力不集中和波動(dòng)性意識(shí)水平下降超過24小時(shí)，常發(fā)生于術(shù)后1到7天。7ppt課件術(shù)后譫妄是常見于外科手術(shù)后，已被定義為一種Dementia,incontrast,isachronic,irreversibleprogressivediseasethataffectsmostlyolderadults,oftenexistspriortosurgeryandanesthesia.Memoryimpairmentisoneofthehallmarksofdementia.8ppt課件Dementia,incontrast,isach與此相反，癡呆是一種慢性的，不可逆的漸進(jìn)性的疾病，主要影響的是老年人，往往存在于手術(shù)和麻醉前，記憶力障礙是老年癡呆癥的標(biāo)志之一。9ppt課件與此相反，癡呆是一種慢性的，不可逆的漸進(jìn)性的疾病，主要影響的POCDischaracterizedbyalong-termstablecognitiveimpairment,whichisconsideredtobereversible,butmaypersistuptomonthsaftersurgery.POCDcanbedifferentiatedfrompostoperativedelirium,sincePOCDhasalongerdurationandnofluctuationsinimpairedcognitivefunctioning.10ppt課件POCDischaracterizedbyaPOCD的特征在于，它是一個(gè)長期穩(wěn)定的認(rèn)知功能障礙，這種認(rèn)知功能障礙被認(rèn)為是可逆的，但可能會(huì)持續(xù)到手術(shù)后幾個(gè)月。

POCD可以與術(shù)后譫妄相鑒別，是因?yàn)镻OCD持續(xù)很長一段時(shí)間并且沒有認(rèn)知功能受損的波動(dòng)性。11ppt課件POCD的特征在于，它是一個(gè)長期穩(wěn)定的認(rèn)IncidenceanddiagnosisTheexactincidenceofPOCDisunknown.Inclinicalpractice,patientsarecurrentlyonlytestedaftersurgery,ifthereisasuspicionofPOCD.Therefore,thecurrentincidenceratesareanunderestimation.12ppt課件IncidenceanddiagnosisTheexadiagnosisPOCD的診斷主要是認(rèn)知能力測(cè)試。在過去的幾十年里，神經(jīng)心理測(cè)驗(yàn)已被用來測(cè)量病人的認(rèn)知能力。多個(gè)測(cè)試可用來評(píng)估不同領(lǐng)域的認(rèn)知功能障礙，如定向力，記憶力，執(zhí)行能力等，然而，所有的測(cè)試都有其局限性，現(xiàn)在測(cè)試評(píng)估POCD的方式還沒有達(dá)成共識(shí)。13ppt課件diagnosisPOCD的診斷主要是認(rèn)PotentialmechanismsofPOCDTheetiologyofPOCDisstillunknown.However,overthelastdecademultiplestudieshavebeenperformedonthistopic.POCD的病因仍然未知，然而已經(jīng)提出了幾個(gè)關(guān)于POCD發(fā)展的途徑。14ppt課件PotentialmechanismsofPOCD外科手術(shù)導(dǎo)致系統(tǒng)性的應(yīng)激反應(yīng)，釋放神經(jīng)內(nèi)分泌激素及炎癥因子，這些細(xì)胞因子可能使腦功能發(fā)生改變并促進(jìn)POCD的發(fā)展；POCD經(jīng)常發(fā)生在心臟手術(shù)的病人，可能與術(shù)后過度復(fù)溫有關(guān)；血清中S-100蛋白濃度的增加可促進(jìn)POCD的發(fā)展；大腦細(xì)胞凋亡是POCD的一個(gè)潛在機(jī)制。15ppt課件外科手術(shù)導(dǎo)致系統(tǒng)性的應(yīng)激反應(yīng)，釋放神經(jīng)內(nèi)分泌激素及炎癥因子，RiskfactorsforPOCDSurgery-related?risk?factorsCardiacsurgeryMajorandinvasivesurgeryLongoperationdurationPostoperativecomplicationsPatient-related?risk?factorsIncreasedageHistoryofalcoholabusePreviousPOCDHistoryofstrokeHigherASAclassification16ppt課件RiskfactorsforPOCDSurger教育程度與POCDThelowereducationallevelfitswiththe“threshold”theoryforcognitivedecline:ifapatienthasalowereducationallevel,he/sheismorevulnerabletocognitivedecline.Asmalldeclinemay,therefore,resultincognitiveimpairment,whilepatientswithahighereducationallevelstillmightbeonanormalcognitivefunctionallevelevenafteracognitivedecline17ppt課件教育程度與POCDThelowereduca

教育程度較低，適合于認(rèn)知功能下降的“門檻”理論：如果病人有較低的教育水平，他/她更容易產(chǎn)生認(rèn)知能力下降，一個(gè)小的下降可能會(huì)導(dǎo)致認(rèn)知功能障礙，而患者具有較高的教育水平即使在認(rèn)知能力下降時(shí)，其仍然可能在一個(gè)正常的認(rèn)知功能水平。18ppt課件教育程度較低，適合于認(rèn)知功能下降的“門檻

OtherriskTheuseofbenzodiazepines，thedosageoffentanylanddifferentvolatileanestheticsdidnotaffecttheoccurrenceofPOCD.Hypoperfusionorhypoxiaofthebrainduetobloodloss,systemichypotension,orhypoxiahavebeenthoughttobepotentialcausesofPOCDintheperioperativeperiod.19ppt課件

OtherriskTheuseo手術(shù)及麻醉與POCDHowever,itisnotclearwhetherPOCDisprovokedbysurgeryand/oranesthesiaitself.ItwasthoughtthatthetypeofanesthesiaalsocontributedtothedevelopmentofPOCD.

目前尚不清楚手術(shù)和/或麻醉本身是否也引起POCD。麻醉的類型與POCD的發(fā)生也有關(guān)系。20ppt課件手術(shù)及麻醉與POCDHowever,iti麻醉方式與POCD一項(xiàng)研究：428例年齡在60歲及以上，行非心臟手術(shù)患者，隨機(jī)分為2組，局域麻醉與全麻組，術(shù)后3個(gè)月認(rèn)知功能障礙發(fā)生率分別是全麻為14.3％和局域麻醉為13.9％。ThesefindingsmakeitlesslikelythatPOCDisassociatedwithtypeofanesthesia.21ppt課件麻醉方式與POCD一項(xiàng)研究：428例年齡在60歲及以上，行非PreventionandprophylaxisTheknowledgeonpreventivestrategiesforPOCDislimited.However,theremightbeseveraloptionstoreducetheriskofthedevelopmentofPOCDinolderadults.22ppt課件PreventionandprophylaxisPreoperativelyFirstofall,itisimportanttorecognizepotentialriskfactorspreoperatively.Avoidlong-actingbenzodiazepines.23ppt課件PreoperativelyFirstofall,itIntraoperativelyItmightbehelpfultouseanestheticsthathavealowmetabolicrateandrapidpharmacokinetics.Furthermore,ashorterandlessinvasivesurgicalprocedureisassociatedwithalowerrateofPOCD.Incardiothoracicpatients,slowrewarmingandprolongedmildhypothermiamaycontributetothepreventionofthedevelopmentofPOCDafterextracorporalcirculation.24ppt課件IntraoperativelyItmightbehe術(shù)中應(yīng)用麻醉劑是有益處的，使機(jī)體處于一種低的代謝率及高的藥物代謝動(dòng)力學(xué)。較短的微創(chuàng)外科手術(shù)與POCD的發(fā)生率降低有關(guān)。在心胸外科患者中，體外循環(huán)后，緩慢復(fù)溫并持續(xù)亞低溫治療可能有助于預(yù)防POCD的發(fā)展。25ppt課件術(shù)中應(yīng)用麻醉劑是有益處的，使機(jī)體處于一種低的代謝率及高的藥物PostoperativelyAdequatepaintreatmentreducestheincidenceofPOCD.Furthermeasuresincludemaintaininga“normal”day–nightrhythm,andmaintainingthehomeostasisbyavoidingtoolongfastingbeforeandaftertheprocedure.FrequentvisitsbyfamilyandfriendswhilethepatientisstillinthehospitalandearlydischargeofpatientstotheirownhomeenvironmentalsoleadtoareducedincidenceofPOCD26ppt課件PostoperativelyAdequatepainConclusionPOCD是一個(gè)主要見于大手術(shù)術(shù)后，其嚴(yán)重影響病人的術(shù)后結(jié)果。老年人發(fā)生POCD的風(fēng)險(xiǎn)增加，因此老人科醫(yī)生，外科醫(yī)生，麻醉師要了解POCD的診斷，風(fēng)險(xiǎn)因素，以及可能的預(yù)防和治療的方法。由于POCD可能長期存在，以及越來越多的老年人接受手術(shù)，我們應(yīng)作出更多努力，以獲得更多關(guān)于POCD的病理生理機(jī)制。27ppt課件ConclusionPOCD是一個(gè)主要見于Thankyou!28ppt課件Thankyou!28ppt課件老年患者術(shù)后認(rèn)知功能障礙Postoperative?

cognitive?dysfunction?

in?geriatric?patients29ppt課件老年患者術(shù)后認(rèn)知功能障礙Postoperative?

cogDelirium,dementia,andPOCDIncidenceanddiagnosisPotentialmechanismsofPOCDRiskfactorsPreventionandprophylaxisConclusion30ppt課件Delirium,dementia,andPOCD2pPostoperativecognitivedysfunction(POCD)isfrequentlyseenaftersurgicalprocedures.POCDisaseriouscomplicationandischaracterizedbyafunctionaldeclinewhichmaypersistformonths.31ppt課件Postoperativecognitivedysfun術(shù)后認(rèn)知功能障礙（POCD）是外科手術(shù)術(shù)后常見的并發(fā)癥，其特征是持續(xù)數(shù)月的功能下降。尤其是老年患者，其生理上發(fā)生改變，對(duì)于手術(shù)，麻醉及一般住院帶來的壓力的能力減弱，而且老年患者越來越多，POCD更引起人們的關(guān)注。32ppt課件術(shù)后認(rèn)知功能障礙（POCD）是外科手術(shù)術(shù)后常見的并發(fā)癥，其特Delirium,dementia,andPOCDPOCDisoftenconfusedwithdementiaoracutepostoperativedelirium.POCD經(jīng)常與老年癡呆及急性術(shù)后譫妄相混淆。33ppt課件Delirium,dementia,andPOCDPostoperativedeliriumisfrequentlyseenfollowingasurgicalprocedureandhasbeendefinedasanacutechangeinmentalstatus,withinattentionandfluctuatingreducedlevelsofconsciousnessover24h.Themajorityofpostoperativedeliriumcasesoccurbetweendays1and7aftertheoperation.34ppt課件Postoperativedeliriumisf

術(shù)后譫妄是常見于外科手術(shù)后，已被定義為一種急性精神狀態(tài)的改變，表現(xiàn)為注意力不集中和波動(dòng)性意識(shí)水平下降超過24小時(shí)，常發(fā)生于術(shù)后1到7天。35ppt課件術(shù)后譫妄是常見于外科手術(shù)后，已被定義為一種Dementia,incontrast,isachronic,irreversibleprogressivediseasethataffectsmostlyolderadults,oftenexistspriortosurgeryandanesthesia.Memoryimpairmentisoneofthehallmarksofdementia.36ppt課件Dementia,incontrast,isach與此相反，癡呆是一種慢性的，不可逆的漸進(jìn)性的疾病，主要影響的是老年人，往往存在于手術(shù)和麻醉前，記憶力障礙是老年癡呆癥的標(biāo)志之一。37ppt課件與此相反，癡呆是一種慢性的，不可逆的漸進(jìn)性的疾病，主要影響的POCDischaracterizedbyalong-termstablecognitiveimpairment,whichisconsideredtobereversible,butmaypersistuptomonthsaftersurgery.POCDcanbedifferentiatedfrompostoperativedelirium,sincePOCDhasalongerdurationandnofluctuationsinimpairedcognitivefunctioning.38ppt課件POCDischaracterizedbyaPOCD的特征在于，它是一個(gè)長期穩(wěn)定的認(rèn)知功能障礙，這種認(rèn)知功能障礙被認(rèn)為是可逆的，但可能會(huì)持續(xù)到手術(shù)后幾個(gè)月。

POCD可以與術(shù)后譫妄相鑒別，是因?yàn)镻OCD持續(xù)很長一段時(shí)間并且沒有認(rèn)知功能受損的波動(dòng)性。39ppt課件POCD的特征在于，它是一個(gè)長期穩(wěn)定的認(rèn)IncidenceanddiagnosisTheexactincidenceofPOCDisunknown.Inclinicalpractice,patientsarecurrentlyonlytestedaftersurgery,ifthereisasuspicionofPOCD.Therefore,thecurrentincidenceratesareanunderestimation.40ppt課件IncidenceanddiagnosisTheexadiagnosisPOCD的診斷主要是認(rèn)知能力測(cè)試。在過去的幾十年里，神經(jīng)心理測(cè)驗(yàn)已被用來測(cè)量病人的認(rèn)知能力。多個(gè)測(cè)試可用來評(píng)估不同領(lǐng)域的認(rèn)知功能障礙，如定向力，記憶力，執(zhí)行能力等，然而，所有的測(cè)試都有其局限性，現(xiàn)在測(cè)試評(píng)估POCD的方式還沒有達(dá)成共識(shí)。41ppt課件diagnosisPOCD的診斷主要是認(rèn)PotentialmechanismsofPOCDTheetiologyofPOCDisstillunknown.However,overthelastdecademultiplestudieshavebeenperformedonthistopic.POCD的病因仍然未知，然而已經(jīng)提出了幾個(gè)關(guān)于POCD發(fā)展的途徑。42ppt課件PotentialmechanismsofPOCD外科手術(shù)導(dǎo)致系統(tǒng)性的應(yīng)激反應(yīng)，釋放神經(jīng)內(nèi)分泌激素及炎癥因子，這些細(xì)胞因子可能使腦功能發(fā)生改變并促進(jìn)POCD的發(fā)展；POCD經(jīng)常發(fā)生在心臟手術(shù)的病人，可能與術(shù)后過度復(fù)溫有關(guān)；血清中S-100蛋白濃度的增加可促進(jìn)POCD的發(fā)展；大腦細(xì)胞凋亡是POCD的一個(gè)潛在機(jī)制。43ppt課件外科手術(shù)導(dǎo)致系統(tǒng)性的應(yīng)激反應(yīng)，釋放神經(jīng)內(nèi)分泌激素及炎癥因子，RiskfactorsforPOCDSurgery-related?risk?factorsCardiacsurgeryMajorandinvasivesurgeryLongoperationdurationPostoperativecomplicationsPatient-related?risk?factorsIncreasedageHistoryofalcoholabusePreviousPOCDHistoryofstrokeHigherASAclassification44ppt課件RiskfactorsforPOCDSurger教育程度與POCDThelowereducationallevelfitswiththe“threshold”theoryforcognitivedecline:ifapatienthasalowereducationallevel,he/sheismorevulnerabletocognitivedecline.Asmalldeclinemay,therefore,resultincognitiveimpairment,whilepatientswithahighereducationallevelstillmightbeonanormalcognitivefunctionallevelevenafteracognitivedecline45ppt課件教育程度與POCDThelowereduca

教育程度較低，適合于認(rèn)知功能下降的“門檻”理論：如果病人有較低的教育水平，他/她更容易產(chǎn)生認(rèn)知能力下降，一個(gè)小的下降可能會(huì)導(dǎo)致認(rèn)知功能障礙，而患者具有較高的教育水平即使在認(rèn)知能力下降時(shí)，其仍然可能在一個(gè)正常的認(rèn)知功能水平。46ppt課件教育程度較低，適合于認(rèn)知功能下降的“門檻

OtherriskTheuseofbenzodiazepines，thedosageoffentanylanddifferentvolatileanestheticsdidnotaffecttheoccurrenceofPOCD.Hypoperfusionorhypoxiaofthebrainduetobloodloss,systemichypotension,orhypoxiahavebeenthoughttobepotentialcausesofPOCDintheperioperativeperiod.47ppt課件

OtherriskTheuseo手術(shù)及麻醉與POCDHowever,itisnotclearwhetherPOCDisprovokedbysurgeryand/oranesthesiaitself.ItwasthoughtthatthetypeofanesthesiaalsocontributedtothedevelopmentofPOCD.

目前尚不清楚手術(shù)和/或麻醉本身是否也引起POCD。麻醉的類型與POCD的發(fā)生也有關(guān)系。48ppt課件手術(shù)及麻醉與POCDHowever,iti麻醉方式與POCD一項(xiàng)研究：428例年齡在60歲及以上，行非心臟手術(shù)患者，隨機(jī)分為2組，局域麻醉與全麻組，術(shù)后3個(gè)月認(rèn)知功能障礙發(fā)生率分別是全麻為14.3％和局域麻醉為13.9％。ThesefindingsmakeitlesslikelythatPOCDisassociatedwithtypeofanesthesia.49ppt課件麻醉方式與POCD一項(xiàng)研究：428例年齡在60歲及以上，行非PreventionandprophylaxisTheknowledgeonpreventivestrategiesforPOCDislimited.However,theremightbeseveraloptionstoreducetheriskofthedevelopmentofPOCDinolderadults.50ppt課件PreventionandprophylaxisPreoperativelyFirstofall,itisimportanttorecognizepotentialriskfactorspreoperatively.Avoidlong-actingbenzodiazepines.51ppt課件Preoperat