Zusammenfassung
Die postoperative kognitive Dysfunktion (POCD) wird als neu aufgetretene kognitive Funktionsstörung nach einer Operation definiert. Von ihr ist das postoperative delirante Syndrom abzugrenzen, welches durch einen gestörten Schlaf-Wach-Rhythmus, wechselnde Bewusstseinslagen und veränderte psychomotorische Aktivitäten geprägt ist. Die Diagnose POCD ist schwierig zu stellen, da der präoperative kognitive Befund erhoben werden muss. Die Inzidenz variiert stark, abhängig von den verwendeten Testverfahren und untersuchten Kollektiven zwischen 0% und 66%. Es werden eine Frühphase des Auftretens innerhalb der ersten Woche und eine Spätphase unterschieden. Das POCD geht analog zum postoperativen deliranten Syndrom mit einer erhöhten Mortalität einher. Als wesentliche Risikofaktoren gelten höheres Lebensalter und Komorbiditäten, aber auch umfangreiche Eingriffe und lange Anästhesiedauer spielen eine Rolle. Zur POCD-Prävention sollten operative Eingriffe minimalinvasiv und in möglichst kurzer Zeit durchgeführt werden, wobei gut steuerbare Anästhetika verwendet werden sollen. Als pathologisches Korrelat einer POCD finden sich proinflammatorische Zytokine und Metaboliten im zentralen Nervensystem.
Abstract
Postoperative cognitive dysfunction (POCD) is defined as a cognitive decline occurring after surgical intervention. POCD must be distinguished from postoperative delirium, the latter syndrome being characterized by a disrupted sleep-wake rhythm, variable levels of consciousness and altered psychomotor activities. The exact diagnosis of POCD is difficult to make, since the presurgical cognitive state needs to be assessed to confirm a significant change of mental status after surgery. The incidence varies between 0% and 66%, depending on the test procedures used and the patient group. Like postoperative delirium syndrome, POCD is associated with an increased risk of mortality. An early phase within the first week is distinguished from a late phase. Increasing age and co-morbidity have been identified as important risk factors, as have extensive surgical interventions and long-duration anaesthesia. To prevent POCD, surgical trauma should be minimized (e.g. with minimally invasive techniques), while short-acting anaesthetics may be of great benefit. Pro-inflammatory cytokines or metabolites in the central nervous system may play a major role in the development of POCD.
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Bliesener, B., Kleinschmidt, S. & Trupkovic, T. Postoperative kognitive Dysfunktion. Trauma Berufskrankh 12, 123–127 (2010). https://doi.org/10.1007/s10039-010-1620-0
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DOI: https://doi.org/10.1007/s10039-010-1620-0
Schlüsselwörter
- Postoperative kognitive Dysfunktion
- Postoperatives delirantes Syndrom
- Chirurgischer Eingriff
- Anästhesieverfahren
- Testbatterie