普外科肿瘤患者围术期神经认知障碍的研究进展
Progress on Perioperative Neurocognitive Disorders in Patients with General Surgery Tumors
摘要: 围术期神经认知障碍(PND)是普外科肿瘤患者常见的围术期神经系统并发症，会延长住院时间、增加并发症和长期认知障碍的风险，最终影响患者预后及转归，已成为该类患者围术期管理的重点问题。本文从围术期神经认知障碍的流行病学、发病机制、危险因素、预防以及其对普外科肿瘤患者预后的影响等方面进行综述，为麻醉科和普外科医师提供有临床价值的参考意见，并为后续研究提供参考。
Abstract: Perioperative Neurocognitive Disorders (PND) represent a prevalent neurological complication in general surgical oncology patients, which may prolong hospitalization, increase the risk of complications and long-term cognitive impairment, ultimately affecting patient prognosis and outcomes. Consequently, PND has emerged as a critical issue in perioperative management for this patient population. This article provides a comprehensive review of PND from multiple perspectives, including epidemiology, pathogenesis, risk factors, prevention strategies, and its impact on the prognosis of general surgical oncology patients. The review aims to offer clinically valuable insights for anesthesiologists and general surgeons, while also serving as a reference for subsequent research endeavors.
文章引用：李子毅, 王舟. 普外科肿瘤患者围术期神经认知障碍的研究进展[J]. 临床医学进展, 2025, 15(11): 981-988. https://doi.org/10.12677/acm.2025.15113182

参考文献

[1] Evered, L., Silbert, B., Knopman, D.S., Scott, D.A., DeKosky, S.T., Rasmussen, L.S., et al. (2018) Recommendations for the Nomenclature of Cognitive Change Associated with Anaesthesia and Surgery—2018. Anesthesiology, 129, 872-879. [Google Scholar] [CrossRef] [PubMed]
[2] 翟菲菲, 黄宇光. 围术期神经认知障碍: 从术后到术前, 从临床指标到生物学指标[J]. 临床麻醉学杂志, 2019, 35(4): 317-318.
[3] O’ Brien, H., Mohan, H., Hare, C.O., Reynolds, J.V. and Kenny, R.A. (2017) Mind over Matter? The Hidden Epidemic of Cognitive Dysfunction in the Older Surgical Patient. Annals of Surgery, 265, 677-691. [Google Scholar] [CrossRef] [PubMed]
[4] Evered, L., Atkins, K., Silbert, B. and Scott, D.A. (2022) Acute Peri-Operative Neurocognitive Disorders: A Narrative Review. Anaesthesia, 77, 34-42. [Google Scholar] [CrossRef] [PubMed]
[5] Tjeertes, E.K.M., van Fessem, J.M.K., Mattace-Raso, F.U.S., Hoofwijk, A.G.M., Stolker, R.J. and Hoeks, S.E. (2020) Influence of Frailty on Outcome in Older Patients Undergoing Non-Cardiac Surgery—A Systematic Review and Meta-analysis. Aging and disease, 11, 1276-1290. [Google Scholar] [CrossRef] [PubMed]
[6] Ho, M., Nealon, J., Igwe, E., Traynor, V., Chang, H., Chen, K., et al. (2021) Postoperative Delirium in Older Patients: A Systematic Review of Assessment and Incidence of Postoperative Delirium. Worldviews on Evidence-Based Nursing, 18, 290-301. [Google Scholar] [CrossRef] [PubMed]
[7] Zhao, B., Ji, H., Xu, C., Li, D., Xing, Z., Liu, B., et al. (2023) Incidence and Risk Factors of Postoperative Delirium after Pancreatic Cancer Surgery: A Retrospective Study. Surgery Today, 53, 736-742. [Google Scholar] [CrossRef] [PubMed]
[8] Ke, Y., Chew, S., Seet, E., Wong, W.Y., Lim, V., Chua, N., et al. (2023) Risk Factors of Post-Anaesthesia Care Unit Delirium in Patients Undergoing Non-Cardiac Surgery in Singapore. Singapore Medical Journal, 64, 728-731. [Google Scholar] [CrossRef] [PubMed]
[9] Sun, Y., Peng, H. and Wu, T. (2023) Postoperative C-Reactive Protein Predicts Postoperative Delirium in Colorectal Cancer Following Surgery. Clinical Interventions in Aging, 18, 559-570. [Google Scholar] [CrossRef] [PubMed]
[10] Brattinga, B., Plas, M., Spikman, J.M., Rutgers, A., de Haan, J.J., Absalom, A.R., et al. (2022) The Association between the Inflammatory Response Following Surgery and Post-Operative Delirium in Older Oncological Patients: A Prospective Cohort Study. Age and Ageing, 51, afab237. [Google Scholar] [CrossRef] [PubMed]
[11] Liu, H. and Liu, X. (2022) Response: Commentary: Preoperative Status of Gut Microbiota Predicts Postoperative Delirium in Patients with Gastric Cancer. Frontiers in Psychiatry, 13, Article ID: 852269. [Google Scholar] [CrossRef] [PubMed]
[12] Yang, Z., Tong, C., Qian, X., Wang, H. and Wang, Y. (2022) Mechanical Bowel Preparation Is a Risk Factor for Postoperative Delirium as It Alters the Gut Microbiota Composition: A Prospective Randomized Single-Center Study. Frontiers in Aging Neuroscience, 14, Article ID: 847610. [Google Scholar] [CrossRef] [PubMed]
[13] Li, Y., Li, Z., Lv, Q., Gu, Y., Qi, Y., Li, J., et al. (2024) Prevalence and Risk Factors of Postoperative Delirium in Tumor Patients after Free Flap Reconstruction: A Systematic Review and Meta-Analysis of Case-Control Studies. Surgery, 176, 906-917. [Google Scholar] [CrossRef] [PubMed]
[14] Liu, X., Huangfu, Z., Zhang, X. and Ma, T. (2025) Global Research Trends in Postoperative Delirium and Its Risk Factors: A Bibliometric and Visual Analysis. Journal of PeriAnesthesia Nursing, 40, 400-414. [Google Scholar] [CrossRef] [PubMed]
[15] Paunikar, S. and Chakole, V. (2024) Postoperative Delirium and Neurocognitive Disorders: A Comprehensive Review of Pathophysiology, Risk Factors, and Management Strategies. Cureus, 16, e68492. [Google Scholar] [CrossRef] [PubMed]
[16] Suzuki, R., Nakanishi, A., Masuya, M., Fukuroku, K., Taneda, Y. and Matsuura, Y. (2025) Risk Factors for Postoperative Delirium in Patients Undergoing Orthopedic Procedures: A Systematic Review and Meta-Analysis. PLOS ONE, 20, e0321025. [Google Scholar] [CrossRef] [PubMed]
[17] Yang, Z., Wang, X., Yang, L., Fang, C., Gu, X. and Guo, H. (2020) Prevalence and Risk Factors for Postoperative Delirium in Patients with Colorectal Carcinoma: A Systematic Review and Meta-Analysis. International Journal of Colorectal Disease, 35, 547-557. [Google Scholar] [CrossRef] [PubMed]
[18] Tian, J., Hao, X., Cao, F., Liu, J., Li, Y., Guo, Y., et al. (2023) Preoperative Frailty Assessment Predicts Postoperative Mortality, Delirium and Pneumonia in Elderly Lung Cancer Patients: A Retrospective Cohort Study. Annals of Surgical Oncology, 30, 7442-7451. [Google Scholar] [CrossRef] [PubMed]
[19] 马垚, 李婷, 张秋实, 等. 60岁以上原发性肝癌患者术后谵妄发生风险预测模型的构建及验证[J]. 临床肝胆病杂志, 2024, 40(9): 1816-1821.
[20] Taylor, J., Payne, T., Casey, C., Kunkel, D., Parker, M., Rivera, C., et al. (2023) Sevoflurane Dose and Postoperative Delirium: A Prospective Cohort Analysis. British Journal of Anaesthesia, 130, e289-e297. [Google Scholar] [CrossRef] [PubMed]
[21] Mueller, A., Spies, C.D., Eckardt, R., Weiss, B., Pohrt, A., Wernecke, K., et al. (2020) Anticholinergic Burden of Long-Term Medication Is an Independent Risk Factor for the Development of Postoperative Delirium: A Clinical Trial. Journal of Clinical Anesthesia, 61, Article 109632. [Google Scholar] [CrossRef] [PubMed]
[22] Lai, C., Liu, K., Tsai, C., Hsu, J., Hsueh, S., Hung, C., et al. (2023) Risk Factors and Effect of Postoperative Delirium on Adverse Surgical Outcomes in Older Adults after Elective Abdominal Cancer Surgery. Asian Journal of Surgery, 46, 1199-1206. [Google Scholar] [CrossRef] 
[23] 闫红, 辛艳, 侯念果, 等. 老年腹腔镜肝部分切除术后认知功能障碍的影响因素[J]. 青岛大学学报(医学版), 2023, 59(3): 425-429.
[24] Dheer, A., Jain, V., Kushwah, N., Kumar, R., Prasad, D. and Singh, S.B. (2018) Temporal and Spatial Changes in Glial Cells during Chronic Hypobaric Hypoxia: Role in Neurodegeneration. Neuroscience, 383, 235-246. [Google Scholar] [CrossRef] [PubMed]
[25] Chen, J., Ji, X. and Xing, H. (2022) Risk Factors and a Nomogram Model for Postoperative Delirium in Elderly Gastric Cancer Patients after Laparoscopic Gastrectomy. World Journal of Surgical Oncology, 20, Article No. 315. [Google Scholar] [CrossRef] [PubMed]
[26] Rostoft, S. and Hamaker, M.E. (2020) Basic Geriatric Principles for Colorectal Surgeons: How to Optimize Assessment and Care of Older Patients in the Perioperative Period. European Journal of Surgical Oncology, 46, 310-315. [Google Scholar] [CrossRef] [PubMed]
[27] 周兴, 杨吉安, 彭凡凡, 等. 局部脑氧饱和度监测目标导向管理对行腹腔镜肝切除术老年肝癌患者术后认知功能的影响[J]. 山东医药, 2025, 65(4): 78-82.
[28] Takahashi, N., Hiraki, A., Kawahara, K., Nagata, M., Yoshida, R., Matsuoka, Y., et al. (2021) Postoperative Delirium in Patients Undergoing Tumor Resection with Reconstructive Surgery for Oral Cancer. Molecular and Clinical Oncology, 14, Article No. 60. [Google Scholar] [CrossRef] [PubMed]
[29] Yuan, Y., Gu, Q., Zhu, M., Zhang, Y. and Lan, M. (2023) Frailty-Originated Early Rehabilitation Reduces Postoperative Delirium in Brain Tumor Patients: Results from a Prospective Randomized Study. Asia-Pacific Journal of Oncology Nursing, 10, Article 100263. [Google Scholar] [CrossRef] [PubMed]
[30] Ma, X., Lv, S., Wei, S., Mao, B., Zhao, X., Jiang, X., et al. (2023) Influences of Dexmedetomidine on Stress Responses and Postoperative Cognitive and Coagulation Functions in Patients Undergoing Radical Gastrectomy under General Anesthesia. World Journal of Gastrointestinal Surgery, 15, 1169-1177. [Google Scholar] [CrossRef] [PubMed]
[31] Wang, Z., Shen, Z., Wang, H., Zhang, L. and Dong, R. (2020) Effect of Dexmedetomidine on the Cognitive Function of Patients Undergoing Gastric Cancer Surgery by Regulating the PI3K/AKT Signaling Pathway. Oncology Letters, 19, 1151-1156. [Google Scholar] [CrossRef] [PubMed]
[32] Zhang, J., Liu, G., Zhang, F., Fang, H., Zhang, D., Liu, S., et al. (2019) Analysis of Postoperative Cognitive Dysfunction and Influencing Factors of Dexmedetomidine Anesthesia in Elderly Patients with Colorectal Cancer. Oncology Letters, 18, 3058-3064. [Google Scholar] [CrossRef] [PubMed]
[33] Ding, Y., Yu, J., Cui, F. and Li, J. (2022) Comparison of Intravenous and Inhalational Anesthetic on Postoperative Cognitive Outcomes in Elderly Patients Undergoing Cancer Surgery: Systematic Review and Meta-Analysis. Journal of PeriAnesthesia Nursing, 37, 683-690. [Google Scholar] [CrossRef] [PubMed]
[34] 刘双双. 吸入不同时长七氟烷复合丙泊酚麻醉对老年患者围术期神经认知障碍的影响[D]: [硕士学位论文]. 秦皇岛: 华北理工大学, 2020.
[35] Yang, L., Xiong, R., Chen, X., Wang, S. and Yu, D. (2024) The Influence of Dexmedetomidine Added to Ropivacaine for Transversus Abdominis Plane Block on Perioperative Neurocognitive Disorders after Radical Colorectal Cancer Surgery: Randomized, Double-Blind, Controlled Trial. BMC Anesthesiology, 24, Article No. 186. [Google Scholar] [CrossRef] [PubMed]
[36] Shen, L., Chen, J., Yang, X., Hu, J., Gao, W., Chai, X., et al. (2022) Flurbiprofen Used in One-Lung Ventilation Improves Intraoperative Regional Cerebral Oxygen Saturation and Reduces the Incidence of Postoperative Delirium. Frontiers in Psychiatry, 13, Article ID: 889637. [Google Scholar] [CrossRef] [PubMed]
[37] Won, Y.J., Oh, S.K., Lim, B.G., Kim, Y.S., Lee, D.Y. and Lee, J.H. (2023) Effect of Surgical Pleth Index-Guided Remifentanil Administration on Perioperative Outcomes in Elderly Patients: A Prospective Randomized Controlled Trial. BMC Anesthesiology, 23, Article No. 57. [Google Scholar] [CrossRef] [PubMed]
[38] Ikeuchi, S., Tanaka, R., Sugiura, T., Shinsato, K., Wakabayashi, A., Sato, J., et al. (2023) Efficacy of Combined Use of Suvorexant and Ramelteon in Preventing Postoperative Delirium: A Retrospective Comparative Study. Journal of Pharmaceutical Health Care and Sciences, 9, Article No. 42. [Google Scholar] [CrossRef] [PubMed]
[39] O’Hanlon, S., Baxter, M. and Hosie, A. (2021) Postoperative Delirium in Older Patients with Cancer: The Role of Psychological Distress and Social Support. Current Opinion in Supportive & Palliative Care, 16, 38-47. [Google Scholar] [CrossRef] [PubMed]
[40] Gearhart, S.L., Do, E.M., Owodunni, O., Gabre-Kidan, A.A. and Magnuson, T. (2020) Loss of Independence in Older Patients after Operation for Colorectal Cancer. Journal of the American College of Surgeons, 230, 573-582. [Google Scholar] [CrossRef] [PubMed]
[41] Katayama, E.S., Stecko, H., Woldesenbet, S., Khalil, M., Munir, M.M., Endo, Y., et al. (2024) The Role of Delirium on Short-and Long-Term Postoperative Outcomes Following Major Gastrointestinal Surgery for Cancer. Annals of Surgical Oncology, 31, 5232-5239. [Google Scholar] [CrossRef] [PubMed]

为你推荐