Postoperative delirium and postoperative cognitive dysfunction are two different concepts, so be careful not to confuse them. Author: Anesthesia small medical Source: Medical Center Anesthesia Channel First, the definition of 谵妄 谵妄 is an acute brain organic mental disorder that is specifically used to describe a particular type of mental disorder. In addition to the general manifestations of insanity, the characteristic manifestations of jealousy are prominent perceptual obstacles, horror illusions and vivid dreams, strange and absurd illusions and illusions arranged in a kaleidoscope, can not fall asleep, have a horrifying tendency, a strong fear Sense and other emotional reactions. It is important to point out that postoperative delirium and postoperative cognitive dysfunction are two different concepts. Postoperative cognitive dysfunction is more difficult to define and involves a wider range of cognition, such as memory, information processing and executive functions. And, in general, postoperative cognitive dysfunction is not conducive to early diagnosis, and even many patients are not diagnosed until they are found or found to be dysfunctional in life or work, but postoperative delirium usually occurs after surgery. In the early stage, acute cognitive dysfunction was the main manifestation. Second, the pathogenesis of cockroaches 1. The neurotransmitter hypothesis suggests that postoperative delirium is similar to degenerative changes in the aged central nervous system such as senile dementia. As the age increases, brain morphology will change, the whole brain volume will decrease, the number and volume of neurons will decrease, dendrites and synapses will decrease, brain metabolism will decrease, and some hormone levels will also change, such as corticosteroids. The level is abnormally elevated. Old age will reduce the activity of acetylcholine acetyltransferase, but the acetylcholine esterase of acetylcholine will not change, resulting in a total reduction of acetylcholine levels in the brain, which will eventually lead to an abnormal increase in dopamine levels, so the long-term use is widely used in clinical practice. Ning, atropine and other anticholinergic drugs that can pass the blood-brain barrier can increase the risk of postoperative delirium in patients. 2. The immune response and stress response caused by stress response, trauma, infection can increase the release of some cytokines (interleukins, tumor necrosis factors, interferons). These cytokines increase the activity of the hypothalamus-pituitary-adrenal axis. And promote the monoamine cycle, which is characterized by activation of norepinephrine, serotonin, increase of dopamine, reduction of acetylcholine, and increased levels of adrenaline and norepinephrine in human blood during stress, leading to accelerated cerebral blood flow and increased oxygen consumption. If the duration is prolonged, it can cause paralysis. 3, anesthetic drugs widely affect the central nervous system, including nerve cell membranes, receptors, ion channels, neurotransmitters, cerebral blood flow and metabolism. The main function of the central muscarinic cholinergic system is to maintain the mind. A variety of anesthetics act on the central muscarinic receptor, and the inhibition of central muscarinic cholinergic receptors may be an important etiological mechanism for postoperative delirium. . Studies have shown that sevoflurane inhibits M1, M3 receptors in a dose-dependent manner, and the intravenous anesthetic propofol inhibits the M1 receptor in a dose-dependent manner. The clinical concentration range of fentanyl is a competitive antagonism of the M3 receptor. Object. Third, the risk factors of cockroaches Susceptibility factors : (1) Age, especially for older men over 65 years of age; (2) History of psychotropic drug intake and alcohol abuse; (3) History of previous organic brain diseases, such as dementia, Parkinson's, preoperative cognitive dysfunction and other cerebrovascular diseases. Risk factors: (1) application of sedative, hypnotic, analgesic, anticholinergic and other drugs; (2) Poor general conditions, infection, hypoxia and water, electrolytes, acid-base metabolism disorders, etc.; (3) The operation time is more than 3 h, and the hemodynamic changes during the operation are significant, especially the hypotension time is too long; (4) Environmental impacts, such as postoperative transfer to the ICU, acousto-optic stimulation, use of a catheter, etc.; (5) Postoperative pain may be an independent risk factor for postoperative delirium in patients undergoing non-cardiac surgery. Whether general anesthesia is a risk factor for postoperative delirium remains to be confirmed. Perioperative use of statins may increase the risk of spasticity. Fourth, the diagnostic criteria of sputum 谵妄 Lack of specific clinical diagnostic tests, the diagnosis is mainly based on clinical manifestations, clinical features are hyperactivity, insomnia, tremor and obvious and vivid hallucinations, accompanied by pre- or sputum-related convulsions. The primary symptom of assessing delirium is to understand the patient's underlying cognitive function, which is usually assessed by the Simple Intelligent State Examination (MMSE) when the patient is admitted to the hospital. Diagnostic criteria for the diagnosis of sputum mainly in the American Psychiatric Association, 4th edition of the Diagnostic and Statistical Manual of Psychiatry (DSM-IV-TR), 谵妄Evaluation Method (CAM), 谵妄 Rating Scale Revision (DRS-R- 98), 谵妄 observation scale (DOS), elderly inpatient behavior observation scale (GIP) and so on. CAM was prepared by Professor Inouye of the United States according to the Diagnostic Criteria of the American Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition (DSM-III-R). It is used for clinically assisted diagnosis of senile sputum abroad and has good reliability. The validity and validity can be assessed within 2 to 5 minutes, which is suitable for clinical use. Five, treatment of sputum The patient is diagnosed with sputum after surgery. The primary treatment principle is to accurately diagnose and treat the potential triggering factors causing sputum, and timely symptomatic treatment to avoid the deterioration of the disease and life-threatening. The purpose of medical treatment for mild sputum is to calm, control mental symptoms, and improve sleep quality. Commonly used drugs are triazolam, noroxyl stability and other short-acting and intermediate-acting benzodiazepines, avoiding the use of long-acting sedatives and anti-cholinergic drugs that can cause exacerbations, such as barbiturates, antihistamines and phenols. Thiazide drugs. The purpose of drug treatment for patients with obvious mental abnormal behavior and severe agitation is to eliminate the patient's bad stress psychology and reaction, reduce the risk factors for further aggravating the disease, and avoid energy consumption. At present, the most commonly used in clinical and scientific research are butyrylbenzene drugs. Although these drugs have strong antipsychotic, anti-anxiety and sedative characteristics, their complications are worth noting. In particular, the first-generation antipsychotic drug haloperidol can induce lethal torsade ventricular tachycardia after intravenous injection, so the patient's EEG should be monitored and serum K+ and Mg2+ levels monitored. The second and third generations of new antipsychotic drugs have mild anticholinergic side effects without affecting metabolism and may even reduce dopamine levels in the brain. Therefore, it is currently difficult to determine the effect of such drugs on the prognosis of sputum. Six, prevention of cockroaches Positive and appropriate treatment during the perioperative period can reduce the incidence of postoperative delirium and reduce the severity of the disease. Active adjustment before surgery to maintain the patient's water, electrolytes, acid-base balance, improve the general situation of patients and give the necessary psychological preparation. During anesthesia, try to avoid the use of drugs that induce sputum, as long as the condition allows, to maintain the hemodynamic stability of the patient as much as possible. Minimize the operation that may cause changes in the patient's environment during surgery, and shorten the time that the malignant stimulus causes damage to the body. Postoperative pain management should be strengthened to ensure adequate sleep. references 1. Liu Chao, Han Xinyu, et al. Progress in postoperative delirium in elderly patients [J]. Journal of Practical Medicine, 2013; 29 (12). 2. Sun Wei. Research progress in postoperative delirium. China Medical Herald, 2008; 5 (3). 3. Li Na,Xu Xiufeng.Research progress in postoperative delirium in elderly patients[J].Chinese Journal of Gerontology,2008;9(28). Our Two In One Function Rollator walker can also be used as a sturdy transport chair, which comes with a removable storage bag to store your personal accessories to keep your hands free, Rollator With Footrest neatly store your other items on the seat for a short trip. 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