丙泊酚在胃肠镜麻醉中对认知功能影响的研究进展

Research Progress on the Effect of Propofol on Cognitive Function in Gastrointestinal Endoscopy Anesthesia

摘要: 在舒适化医疗全面普及的背景下，无痛胃肠镜已成为消化道疾病早筛早治的核心手段。丙泊酚凭借起效迅速、作用时程短、苏醒彻底的优势，目前仍是门诊胃肠镜镇静麻醉的首选药物。但越来越多临床研究证实，丙泊酚可通过调控中枢受体表达、诱发海马神经炎症、氧化应激及突触可塑性损伤等多重途径干扰认知功能，尤其在老年、基线认知储备不足人群中易诱发一过性甚至持续性术后认知功能障碍，使其临床认知安全性争议日益凸显。当前国内外关于丙泊酚剂量、镇静深度与认知损伤的量效关系、损伤持续时间及高危易感特征仍未形成统一结论，研究异质性显著。本文系统梳理丙泊酚的药理学特征、中枢麻醉机制及海马神经损伤通路，总结MMSE、MoCA等围术期认知评估工具的应用优势与局限，重点对比丙泊酚与瑞马唑仑、环泊酚在药理机制、认知安全性、苏醒质量及临床适用性的差异。通过汇总近年代表性临床研究数据并开展批判性分析，深入阐释丙泊酚剂量–认知损伤争议的核心诱因，明确年龄、基线认知水平、镇静方案及复合用药等关键调控因素。本文着重阐述丙泊酚所致的认知整体损伤特征与独特的“认知–精神运动分离”恢复规律，归纳现有研究短板，并构建围术期认知风险分层与全流程防控体系。基于现有证据总结临床最优用药策略与个体化选药原则，展望未来标准化评估、机制挖掘、精准麻醉及新型镇静药物对比研究方向，旨在为无痛胃肠镜丙泊酚麻醉方案的精准优化、降低围术期认知损伤风险、提升患者诊疗安全性与远期预后提供循证依据与理论参考。

Abstract: With the comprehensive popularization of comfortable medical care, painless gastrointestinal endoscopy has become an essential tool for the early screening and treatment of digestive tract diseases. Propofol remains the first-choice sedative agent for outpatient gastrointestinal endoscopy due to its rapid onset, short duration and high recovery quality. However, accumulating clinical evidence indicates that propofol may induce perioperative cognitive impairment by regulating central receptor activity, activating hippocampal neuroinflammation and oxidative stress, and inhibiting synaptic plasticity. Postoperative cognitive dysfunction (POCD) is particularly prominent in elderly patients and individuals with insufficient baseline cognitive reserve, leading to ongoing controversies regarding its cognitive safety. At present, the dose-effect relationship, duration of cognitive damage and high-risk susceptibility characteristics of propofol remain inconsistent across studies with significant heterogeneity. This review systematically summarizes the pharmacological properties, central anesthetic mechanisms and hippocampal neurotoxic pathways of propofol, and clarifies the advantages and limitations of perioperative cognitive assessment tools including MMSE and MoCA. Meanwhile, it conducts a horizontal comparison of pharmacological mechanisms, cognitive safety, recovery quality and clinical applicability among propofol, remimazolam and ciprofol. Based on summarized clinical studies and critical analysis, this paper explains the internal causes of inconsistencies in dose-cognition research, and analyzes core influencing factors such as age, baseline cognitive function, sedation strategy and combined medication. It highlights the overall cognitive impairment characteristics and the unique “cognitive-psychomotor dissociation” phenomenon after propofol sedation, constructs a full-process perioperative cognitive risk management system, and summarizes the shortcomings of current studies. Future research directions are proposed to promote standardized cognitive evaluation, precise anesthetic management and optimized selection of novel sedative drugs. This review aims to provide evidence-based theoretical support for optimizing propofol anesthesia regimens, reducing perioperative cognitive risks and improving the long-term prognosis of patients undergoing painless gastrointestinal endoscopy.