老年术后认知功能障碍研究进展及思考

术后认知功能障碍(postoperative cognitive dysfunction,POCD)是临床上老年患者术后常见的并发症,主要表现为精神活动、人格、记忆力和社交活动以及认知能力的异常,渐渐为患者和医学工作者所重视,但其病因和发病机制尚不清楚.运用哲学的基本原理,掌握科学的方法论和辩证思维方法,有助于正确分析POCD的相关病因及其发病机制,从而更好定指导临床工作.     

术后认知障碍,麻醉医生能做什么

术后认知功能障碍(POCD)是一种常见于老年患者的术后神经系统并发症,可增加术后死亡率。由于没有统一的诊断标准,报道的POCD发病率有很大差异。POCD危险因素主要包括老年、心脏手术、麻醉方式、应激反应、微血栓等。近年来,关于POCD的研究取得了很大的进展。但其发病病因和机制尚不清楚,临床仍然缺乏有效的预防和治疗手段。术前大剂量应用地塞米松、远端缺血预处理等方法对预防POCD作用不大,术前应用右美托咪定、昂丹司琼、中医中药等使POCD改善。     

术后认知功能障碍病因探索的反思

术后认知功能障碍(POCD)是手术后的一个并发症,随着接受手术治疗的患者越来越多,这一并发症引起了医学家们的广泛关注。但到目前为止,其发病的原因和机制尚不清楚。通过查找总结国内外学者对术后认知功能障碍病因的研究过程,我们发现其中无不渗透着哲学的思想。     

术后认知功能障碍病因探索的反思

术后认知功能障碍(POCD)是手术后的一个并发症,随着接受手术治疗的患者越来越多,这一并发症引起了医学家们的广泛关注.但到目前为止,其发病的原因和机制尚不清楚.通过查找总结国内外学者对术后认知功能障碍病因的研究过程,我们发现其中无不渗透着哲学的思想.     

术毕静注新斯的明对老年患者术后早期认知功能障碍发病率的影响

为评价术毕静注新斯的明拮抗肌松残余效应时对老年患者术后早期认知功能障碍(POCD)发病率的影响,回顾性分析笔者所在医院2007年6月~2017年6月65岁以上在气管内插管全凭静脉麻醉下行髋关节置换术的老年患者1 372例,根据术毕是否静注新斯的明拮抗肌松残余效应,将其分为新斯的明组(n=597)及非新斯的明组(n=775)。术毕待开始有自主呼吸或四个成串刺激(TOF)出现2个反应(T_1和T_2)时,静脉注射新斯的明1mg~2mg拮抗肌松残余效应或不用新斯的明待肌力自然恢复。统计在麻醉恢复室(PACU)内停留时间、术后阿托品用量及POCD的发病率等指标。结果发现术后阿托品用量,新斯的明组明显高于非新斯的明组,在PACU内停留时间及早期POCD发病率新斯的明组明显短(低)于非新斯的明组(P0.05)。综上所述,术毕静注新斯的明拮抗肌松残余效应时可能降低行髋关节置换术的老年患者早期POCD的发病率。     

术后认知功能障碍和阿尔茨海默病相关的发病机制思考

术后认知功能障碍是手术麻醉后的并发症之一,阿尔茨海默病是一种常见的慢性进行性神经退行性疾病,在发病机制方面二者存在诸多的相似点,且目前在此方面对二者的研究都没有取得重大进展,有必要从发病机制角度对二者进行相关的辩证思考,以便更好地指导临床及基础研究。     

右美托咪定对老年患者术后认知功能障碍及血浆皮质醇浓度的影响

探讨右美托咪定(Dex)对老年患者术后认知功能障碍(POCD)及血浆皮质醇的影响。择期行腹部手术老年患者60例,随机分成2组:D组(0.5μg/kg/h泵注Dex至手术结束前30min)和对照组(C组)(泵注等量的生理盐水,方法同D组),术前1d(T_0),术后1d(T_1),术后3d(T_2),术后5d(T_3),术后7d(T_4)进行MMSE评分并测定血浆皮质醇浓度。与T0比较,两组患者MMSE评分在T_1、T_2和T_3时均下降,且D组显著高于C组,差异有统计学意义(P0.05)。与T0比较,两组患者皮质醇浓度在T_1、T_2、T_3时明显升高(P0.05),且D组显著低于C组(P0.05)。Dex降低老年患者POCD发生率可能与其降低应激反应时血浆皮质醇浓度有关。     

术后认知功能障碍和阿尔茨海默病相关的发病机制思考

术后认知功能障碍是手术麻醉后的并发症之一,阿尔茨海默病是一种常见的慢性进行性神经退行性疾病,在发病机制方面二者存在诸多的相似点,且目前在此方面对二者的研究都没有取得重大进展,有必要从发病机制角度对二者进行相关的辩证思考,以便更好地指导临床及基础研究.     

老年人术后认知功能障碍的影响因素和预防

人口老龄化问题日趋严重,老龄社会已悄然到来,老年人手术,术前、术中、术后都有其独特性,如何避免或者减少手术后并发症的发生,尤其是预防严重并发症的发生意义重大。笔者从老年人生理改变,老年人术后认知功能障碍（postoperative cognitive disorder,POCD）的影响因素以及手术前、手术中（麻醉期）、...     

个体化降压的临床意义

高血压是由多种病因和发病机制引起的一种慢性疾病,可以导致多种靶器官功能损害,并最终导致严重的心、脑血管并发症,危及人类的健康和生命。如何做到有效的预防和治疗是目前面,临的问题。本文分析了高血压控制的现状,以矛盾的特殊性原理为指导,从高血压的病因和发病机制、临床特点以及药物对个体的敏感性等诸多方面出发,阐述了高血压患者个体差异性。高血压患者个体差异性决定每一个个体综合控制策略的不同,运用“具体问题具体分析”的方法,为每一个个体制定个体化的血压控制方案,以期达到理想的高血压整体控制水平。     

That Way Madness Lies: At the Intersection of Philosophy and Clinical Psychology

Abstract: I argue that philosophical practice is a clinically active and influential endeavor, with both positive (therapeutic) and negative (detrimental) psychological possibilities. Though some have explicitly taken the clinical aspects of philosophy into the therapeutic realm via the new field of philosophical counseling, I am interested in the clinical context of philosophers as philosophers, engaged in standard, philosophical pursuits. In arguing for the clinical implications of philosophical practice I consider the relation between philosophical despair and depression, the cognitive etiology of depression and other clinical disorders, selected DSM‐IV entries, attribution theory, and cognitive therapy.     

Delusional thinking and cognitive disorder

A hypothesis is presented regarding the genesis of paranoid delusion that attempts to take into account certain data. The data of interest are (a) the failure to find evidence of cognitive impairment in diagnosed paranoid patients, (b) the evidence of perceptual disorder as a primary and prior condition in the natural history of the clinical development of delusions and the empirical relationship of the perceptual disorder to presence of “thought disorder,” (c) the failure to find evidence supporting universal psychodynamic patterns of etiology, (d) appearance of “delusional” phenomena in normal subjects in situations of deviant sensory experience, and (e) the reports of articulate patients writing of their experiences.     

Do obsessional beliefs discriminate OCD without tic patients from OCD with tic and Tourette's syndrome patients?

There is considerable overlap in symptomatology between Tourette's syndrome (TS) and obsessive-compulsive disorder (OCD). Increased rates of tics are found in OCD and up to 60% obsessive-compulsive symptoms in TS. However, in OCD obsessive-compulsive symptoms are more often anxiety-related and, as a consequence, aimed at anxiety-reduction, whereas in TS these symptoms are more stimulus-bound. Therefore, it is of clinical interest to study whether these phenomenological differences are reflected in differences between dysfunctional cognitions accompanying OC symptoms in OCD with or without tics and TS. Current cognitive theory of OCD ascertains that specific dysfunctional beliefs are important in the etiology and maintenance of OCD. To assess these beliefs, the obsessive-compulsive beliefs questionnaire-87 (OBQ-87) has been developed. In the present study, OBQ-87 scores of OCD patients without tics, OCD with tics, and TS (without OCD) patients were compared to those of normal controls. Results: OCD without tic patients exhibited higher OBQ-87 scores than TS patients. No differences were found between OCD with or without tic patients on any of the OBQ-87 subscales. These results suggest that: (1) dysfunctional beliefs have no discriminative power with respect to OCD with or without tic patients; (2) the direct relationship between types of OC symptoms and specific dysfunctional beliefs is questionable. Therefore, one can doubt the specificity of cognitive theory of OCD to explain specific OC behavior.     

Therapygenetics: moving towards personalized psychotherapy treatment

New research suggests that genetic variation predicts response to cognitive behavior therapy (CBT) for the treatment of pediatric anxiety. We discuss this intriguing finding, review its implications for understanding the etiology of psychopathology, and suggest that psychosocial treatment research would strongly benefit from routinely assessing genetic variation in clinical trials.     

Clinical Effectiveness of an Intensive Outpatient Program for Integrated Treatment of Posttraumatic Stress Disorder and Mild Traumatic Brain Injury

Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) are pervasive consequences of the post-9/11 conflicts. Treatment of PTSD and mTBI has historically occurred separately and sequentially, which does not reflect the overlapping etiology of symptoms and may attenuate or delay recovery. This paper describes an integrated 2-week treatment program using prolonged exposure and cognitive symptom management and rehabilitation therapy to comprehensively treat PTSD and cognitive complaints attributed to mTBI, regardless of etiology. To minimize potential iatrogenic effects of treating presumed mTBI-related symptoms, a central focus of the program was to instill expectations of full recovery. Thirty patients with full or subclinical PTSD and self-reported TBI history completed the PTSD+TBI treatment program. Results indicated that self-reported PTSD, depression, and neurobehavioral symptoms significantly decreased following treatment, while satisfaction with participation in social roles increased. These preliminary effectiveness data indicate that PTSD complicated by mTBI history can be effectively treated within a 2-week intensive outpatient program.     

Influence of education on the pattern of cognitive deterioration in AD patients: the cognitive reserve hypothesis

The cognitive reserve hypothesis proposes that a high educational level could delay the clinical expression of Alzheimer's disease (AD) although neuropathologic changes develop in the brain. Therefore, some studies have reported that when the clinical signs of the disease emerge, high-educated patients may decline more rapidly than low-educated patients because the neuropathology is more advanced. However, these studies have only investigated the decline of global cognition or an isolated cognitive process. To study the differential deterioration pattern of several cognitive processes according to education, the performance of 20 AD patients with a high educational level and a low educational level were compared with the performance of 20 control subjects on a neuropsychological battery. The results showed that cognitive deterioration of AD patients is different according to education, although the global performance was similar in AD patients. The high-educated patients exhibited greater impairment of abstract thinking whereas the low-educated patients showed greater impairment of memory and attentional function. This confirms that some cognitive processes, such as abstract thinking, decline more rapidly in high-educated patients whereas others seem to evolve more slowly if compared to low-educated patients. In this latter case, high-educated patients may still benefit from cognitive reserve after the diagnosis of the dementia.