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Surgery, neuroinflammation and cognitive impairment

机译：手术，神经炎症和认知障碍

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Trauma experienced during surgery can contribute to the development of a systemic inflammatory response that can cause multi-organ dysfunction or even failure. Post-surgical neuroinflammation is a documented phenomenon that results in synaptic impairment, neuronal dysfunction and death, and impaired neurogenesis. Various pro-inflammatory cytokines, such as TNFα, maintain a state of chronic neuroinflammation, manifesting as post-operative cognitive dysfunction and post-operative delirium. Furthermore, elderly patients with post-operative cognitive dysfunction or delirium are three times more likely to experience permanent cognitive impairment or dementia. We conducted a narrative review, considering evidence extracted from various databases including Pubmed, MEDLINE and EMBASE, as well as journals and book reference lists. We found that further pre-clinical and well-powered clinical studies are required to delineate the precise pathogenesis of post-operative delirium and cognitive dysfunction. Despite the burden of post-operative neurological sequelae, clinical studies investigating therapeutic agents, such as dexmedetomidine, ibuprofen and statins, have yielded conflicting results. In addition, evidence supporting novel therapeutic avenues, such as nicotinic and HMGB-1 targeting and remote ischaemic pre-conditioning, is limited and necessitates further investigation.
机译：手术期间经历的创伤可能会导致全身性炎症反应的发展，从而引起多器官功能障碍甚至衰竭。手术后神经炎症是一种有记录的现象，可导致突触损伤，神经元功能障碍和死亡，以及神经发生受损。各种促炎细胞因子（例如TNFα）维持慢性神经炎症状态，表现为术后认知功能障碍和术后del妄。此外，患有术后认知功能障碍或del妄的老年患者发生永久性认知障碍或痴呆的可能性高三倍。我们进行了叙述性回顾，考虑了从包括Pubmed，MEDLINE和EMBASE在内的各种数据库以及期刊和书籍参考清单中提取的证据。我们发现，需要进一步的临床前和功能强大的临床研究来描述术后del妄和认知功能障碍的确切发病机理。尽管术后神经系统后遗症负担沉重，但临床研究治疗药物如右美托咪定，布洛芬和他汀类药物的结果却相矛盾。此外，支持新的治疗途径（如烟碱和HMGB-1靶向和远程缺血预处理）的证据有限，需要进一步研究。

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