糖尿病患者血糖水平对围术期神经认知障碍的影响
Effect of Blood Glucose Levels in Diabetic Pa-tients on Perioperative Neurocognitive Dis-orders
DOI: 10.12677/ACM.2023.13112405, PDF,   
作者: 郭 林*, 张 彤：新疆医科大学第四临床医学院，新疆 乌鲁木齐；曹兴华#：新疆医科大学附属中医医院麻醉科，新疆 乌鲁木齐
关键词: 围术期神经认知障碍；糖尿病；血糖；糖化血红蛋白；Perioperative Neurocognitive Disorders； Diabetes； Blood Glucose； HbA1c
摘要: 围术期神经认知障碍(perioperative neurocognitive disorders, PND)是手术和麻醉公认的神经系统并发症。高龄、教育水平、糖尿病史、围术期血糖控制不佳、麻醉深度等可能是PND的危险因素。关于PND的发生机制尚不明确，而糖尿病患者PND的病理生理机制可能主要与多元醇通路上调和麻醉药物通过中枢神经系统中的胰岛素受体(CNS-IR)影响PI3K/PDK1/AKT信号通路有关。本文对糖尿病患者出现围术期神经认知障碍的研究现状进行综述，从影响因素、发生机制和干预措施等方面进行归纳和分析，旨在为降低糖尿病患者PND发生率以及预防和干预提供参考，提高患者生活质量，改善疾病的预后和加速患者康复。
Abstract: Perioperative neurocognitive disorders (PND) is a major complication of surgery and anesthesia. Advanced age, education level, history of diabetes mellitus, poor perioperative glycemic control, and depth of anesthesia may be risk factors for PND. It is not clear about the mechanism of PND, but the pathophysiological mechanism of PND in diabetic patients may be mainly related to the upreg-ulation of polyol pathway and the influence of narcotic drugs on PI3K/PDK1/AKT signaling pathway through insulin receptors in the central nervous system (CNS-IR). In this paper, we reviewed the current status of research on perioperative neurocognitive disorders in diabetic patients, summa-rized and analyzed multiple aspects such as influencing factors, occurrence mechanisms and inter-ventions, aiming to provide references for preventive interventions to reduce the incidence of PND in diabetic patients, improve the quality of life, improve the prognosis of the disease and accelerate patient recovery after surgery.
文章引用：郭林, 张彤, 曹兴华. 糖尿病患者血糖水平对围术期神经认知障碍的影响[J]. 临床医学进展, 2023, 13(11): 17160-17165. https://doi.org/10.12677/ACM.2023.13112405

参考文献

[1] Evered, L., Culley, D.J. and Eckenhoff, R.G. (2020) Cognitive Dysfunction and Other Long-Term Complications of Surgery and Anesthesia. Elsevier, Philadelphia, 2639-2652.
[2] Nemeth, E., Vig, K., Racz, K., et al. (2017) Influence of the Postoperative Inflammatory Response on Cognitive Decline in Elderly Patients Undergoing On-Pump Cardiac Sur-gery: A Controlled, Prospective Observational Study. BMC Anesthesiology, 17, Article No. 113. [Google Scholar] [CrossRef] [PubMed]
[3] Lachmann, G., Feinkohl, I., Borchers, F., et al. (2018) Diabetes, but Not Hypertension and Obesity, Is Associated with Postoperative Cognitive Dysfunction. Dementia and Geriatric Cognitive Disorders, 46, 193-206. [Google Scholar] [CrossRef] [PubMed]
[4] van Zuylen, M.L., Van Wilpe, R., Ten Hoope, W., et al. (2022) Compari-son of Postoperative Neurocognitive Function in Older Adult Patients with and without Diabetes Mellitus. Gerontology, 69, 189-200. [Google Scholar] [CrossRef] [PubMed]
[5] Liu, Y., Meng, R. and Dong, J. (2022) Effect of Chronic Heart Failure Complicated with Type 2 Diabetes Mellitus on Cognitive Function in the Elderly. Evidence-Based Complementary and Alternative Medicine, 2022, Article ID: 4841205. [Google Scholar] [CrossRef] [PubMed]
[6] Feinkohl, I., Winterer, G. and Pischon, T. (2017) Diabetes, Glycemia and Risk of Post-Operative Cognitive Dysfunction: A Meta-Analysis. Diabetes/Metabolism Research and Reviews, 33, e2884. [Google Scholar] [CrossRef] [PubMed]
[7] Geijselaers, S.L.C., Sep, S.J.S., Stehouwer, C.D.A., et al. (2015) Glucose Regulation, Cognition, and Brain MRI in Type 2 Diabetes: A Systematic Review. The Lancet Diabetes & En-docrinology, 3, 75-89. [Google Scholar] [CrossRef] 
[8] Feinkohl, I., Aung, P.P., Keller, M., et al. (2014) Severe Hypoglycemia and Cognitive Decline in Older People with Type 2 Diabetes: The Edinburgh Type 2 Diabetes Study. Di-abetes Care, 37, 507-515. [Google Scholar] [CrossRef] [PubMed]
[9] Verhulst, C.E.M., Fabricius, T.W., Nefs, G., et al. (2022) Consistent Ef-fects of Hypoglycemia on Cognitive Function in People with or without Diabetes. Diabetes Care, 45, 2103-2110. [Google Scholar] [CrossRef] [PubMed]
[10] Dungan, K.M.M., Braithwaite, S.S.P. and Preiser, J.P. (2009) Stress Hy-perglycaemia. The Lancet (British Edition), 373, 1798-1807. [Google Scholar] [CrossRef] 
[11] Hermanides, J., Qeva, E., Preckel, B., et al. (2018) Perioper-ative Hyperglycemia and Neurocognitive Outcome after Surgery: A Systematic Review. Minerva Anestesiologica, 84, 1178-1188. [Google Scholar] [CrossRef] 
[12] Ehsani, R., Djalali Motlagh, S., Zaman, B., et al. (2020) Effect of General Versus Spinal Anesthesia on Postoperative Delirium and Early Cognitive Dysfunction in Elderly Pa-tients. Anesthesiology and Pain Medicine, 10, e101815. [Google Scholar] [CrossRef] [PubMed]
[13] Czyż-Szypenbajl, K., Mędrzycka-Dąbrowska, W., Kwiecień-Jaguś, K., et al. (2019) Occurrence of Cognitive Dysfunction after Surgery—A Systematic Review. Psychiatria Polska, 53, 145-160. [Google Scholar] [CrossRef] 
[14] 陈莺之, 杨金丽. 心脏手术病人术后认知功能障碍的研究进展[J]. 循证护理, 2022, 8(15): 2060-2063.
[15] 王小礼, 王秀芹, 张丰. 盐酸右美托咪定对老年腹部手术患者术后认知功能障碍的影响[J]. 吉林医学, 2022, 43(5): 1250-1251.
[16] 王萌, 纪汶君, 陈莉娜. 糖尿病性认知功能障碍研究进展[J]. 基础医学与临床, 2015, 35(2): 240-243.
[17] Tigchelaar, C., van Zuylen, M.L., Hulst, A.H., et al. (2022) Elevated Cerebrospinal Fluid Glucose Levels and Diabetes Mellitus Are Associated with Activation of the Neurotoxic Polyol Pathway. Diabetologia, 65, 1098-1107. [Google Scholar] [CrossRef] [PubMed]
[18] Barnea-Goraly, N., Raman, M., Mazaika, P., et al. (2014) Alter-ations in White Matter Structure in Young Children with Type 1 Diabetes. Diabetes Care, 37, 332-340. [Google Scholar] [CrossRef] [PubMed]
[19] Bilotta, F., Lauretta, M.P., Tewari, A., et al. (2017) Insulin and the Brain: A Sweet Relationship with Intensive Care. Journal of Intensive Care Medicine, 32, 48-58. [Google Scholar] [CrossRef] [PubMed]
[20] Badenes, R., Qeva, E., Giordano, G., et al. (2021) Intranasal In-sulin Administration to Prevent Delayed Neurocognitive Recovery and Postoperative Neurocognitive Disorder: A Narra-tive Review. International Journal of Environmental Research and Public Health, 18, Article No. 2681. [Google Scholar] [CrossRef] [PubMed]
[21] Vogt, A.P. and Bally, L. (2020) Perioperative Glucose Management: Current Status and Future Directions. Best Practice & Research Clinical Anaesthesiology, 34, 213-224. [Google Scholar] [CrossRef] [PubMed]
[22] Yang, Y. and Song, W. (2013) Molecular Links between Alz-heimer’s Disease and Diabetes Mellitus. Neuroscience, 250, 140-150. [Google Scholar] [CrossRef] [PubMed]
[23] Lioutas, V., Alfaro-Martinez, F., Bedoya, F., et al. (2015) Intranasal Insulin and Insulin-Like Growth Factor 1 as Neuroprotectants in Acute Ischemic Stroke. Translational Stroke Research, 6, 264-275. [Google Scholar] [CrossRef] [PubMed]
[24] 杨欢, 郑小兰, 徐国海, 等. 电针刺激对糖尿病患者术后认知功能及血清炎性因子的影响[J]. 临床麻醉学杂志, 2015, 31(11): 1073-1076.
[25] Ou, L., Shen, Z., Zhang, T., et al. (2022) Electroacupuncture for the Prevention of Postoperative Cognitive Dysfunction among Older Adults Undergoing Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Frontiers in Medicine, 8, Article ID: 778474. [Google Scholar] [CrossRef] [PubMed]
[26] Yuan, W. and Wang, Q. (2019) Perioperative Acupuncture Medicine: A Novel Concept Instead of Acupuncture Anesthesia. Chinese Medical Journal, 132, 707-715. [Google Scholar] [CrossRef] 
[27] Sieber, F.E., Zakriya, K.J., Gottschalk, A., et al. (2010) Sedation Depth during Spinal Anesthesia and the Development of Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Repair. Mayo Clinic Proceedings, 85, 18-26. [Google Scholar] [CrossRef] [PubMed]
[28] Ding, L., Chen, D.X. and Li, Q. (2020) Effects of Electroencephalog-raphy and Regional Cerebral Oxygen Saturation Monitoring on Perioperative Neurocognitive Disorders: A Systematic Review and Meta-Analysis. BMC Anesthesiology, 20, Article No. 254. [Google Scholar] [CrossRef] [PubMed]
[29] Yu, H., Kang, H., Fan, J., et al. (2022) Influence of Dexme-detomidine on Postoperative Cognitive Dysfunction in the Elderly: A Meta-Analysis of Randomized Controlled Trials. Brain and Behavior, 12, e2665. [Google Scholar] [CrossRef] [PubMed]
[30] Chen, N., Chen, X., Xie, J., et al. (2019) Dexmedetomidine Protects Aged Rats from Postoperative Cognitive Dysfunction by Alleviating Hippocampal Inflammation. Molecular Medicine Reports, 20, 2119-2126. [Google Scholar] [CrossRef] [PubMed]

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