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摘要: 烧伤后认知障碍是烧伤患者诊断和治疗中不可忽略的重要问题,其机制可能与炎症反应的激活、血脑屏障破坏、下丘脑-垂体-肾上腺轴失衡、神经细胞改变等相关。针对其机制,采取预防及治疗措施将是未来减少烧伤后认知障碍的最优选择。该文就烧伤患者认知障碍的流行病学情况及风险因素、可能的发病机制、诊断、治疗及预防相关研究进展进行综述,为及时准确地评估、处理及预防烧伤患者认知障碍提供参考。Abstract: Cognitive disorders after burns is an important problem that cannot be ignored in the diagnosis and treatment of burn patients. Its mechanism may be related to the activation of inflammatory response, destruction of the blood-brain barrier, hypothalamic-pituitary-adrenal axis imbalance, nerve cell changes, etc. Mechanism-specific prevention and treatment will be the best choice to reduce post-burn cognitive disorders in the future. This review introduces the research advances in epidemiology, risk factors, possible pathogenesis, diagnosis, treatment, and prevention of cognitive disorders in burn patients, in order to provide a reference for timely and accurate assessment, treatment, and prevention of cognitive disorders in burn patients.
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Key words:
- Burns /
- Cognition disorders /
- Cognitive function /
- Pathogenesis
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参考文献
(42) [1] 贾建平, 陈生弟. 神经病学[M].8版. 北京: 人民卫生出版社, 2018. [2] 中华医学会神经病学分会神经心理与行为神经病学学组.常用神经心理认知评估量表临床应用专家共识[J].中华神经科杂志,2019,52(3):166-176.DOI: 10.3760/cma.j.issn.1006-7876.2019.03.002. [3] 彭丹涛,朱瑞,许贤豪.《精神障碍诊断与统计手册》-5神经认知障碍诊断标准(草案)[J].中华老年医学杂志,2011,30(1):7-12.DOI: 10.3760/cma.j.issn.0254-9026.2011.01.002. [4] DukeJM,RandallSM,VetrichevvelTP,et al.Long-term mental health outcomes after unintentional burns sustained during childhood: a retrospective cohort study[J/OL].Burns Trauma,2018,6:32[2022-11-17].https://pubmed.ncbi.nlm.nih.gov/30460320/. DOI: 10.1186/s41038-018-0134-z. [5] NumanT,van den BoogaardM,KamperAM,et al.Recognition of delirium in postoperative elderly patients: a multicenter study[J].J Am Geriatr Soc,2017,65(9):1932-1938.DOI: 10.1111/jgs.14933. [6] StanleyG,BarberA,O'BrienAM,et al.Delirium in hospitalised adults with acute burns - a systematic review[J].Burns,2022,48(5):1040-1054.DOI: 10.1016/j.burns.2022.05.023. [7] VetrichevvelTP,RandallSM,FearMW,et al.Burn injury and long-term nervous system morbidity: a population-based cohort study[J].BMJ Open,2016,6(9):e012668.DOI: 10.1136/bmjopen-2016-012668. [8] AbdelrahmanI,ViewegR,IrschikS,et al.Development of delirium: association with old age, severe burns, and intensive care[J].Burns,2020,46(4):797-803.DOI: 10.1016/j.burns.2020.02.013. [9] GuoZ,LiuJ,LiJ,et al.Postoperative delirium in severely burned patients undergoing early escharotomy: incidence, risk factors, and outcomes[J].J Burn Care Res,2017,38(1):e370-e376.DOI: 10.1097/BCR.0000000000000397. [10] HolmesEG,JonesSW,LaughonSL.A retrospective analysis of neurocognitive impairment in older patients with burn injuries[J].Psychosomatics,2017,58(4):386-394.DOI: 10.1016/j.psym.2017.03.002. [11] van YperenDT,RaatsJW,DokterJ,et al.Prevalence and risk factors for delirium in elderly patients with severe burns: a retrospective cohort study[J].J Burn Care Res,2020,41(2):371-376.DOI: 10.1093/jbcr/irz161. [12] BicknellR,KennedyB,PhamT,et al.Thermal injury deaths of community-dwelling older people with dementia[J].Alzheimer Dis Assoc Disord,2020,34(1):101-104.DOI: 10.1097/WAD.0000000000000290. [13] DugganMC,WangL,WilsonJE,et al.The relationship between executive dysfunction, depression, and mental health-related quality of life in survivors of critical illness: results from the BRAIN-ICU investigation[J].J Crit Care,2017,37:72-79.DOI: 10.1016/j.jcrc.2016.08.023. [14] GovermanJ,MathewsK,NadlerD,et al.Satisfaction with life after burn: a burn model system national database study[J].Burns,2016,42(5):1067-1073.DOI: 10.1016/j.burns.2016.01.018. [15] DevlinJW,SkrobikY,GélinasC,et al.Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU[J].Crit Care Med,2018,46(9):e825-e873.DOI: 10.1097/CCM.0000000000003299. [16] LinX,ChenY,ZhangP,et al.The potential mechanism of postoperative cognitive dysfunction in older people[J].Exp Gerontol,2020,130:110791.DOI: 10.1016/j.exger.2019.110791. [17] EsechieA,BhardwajA,MaselT,et al.Neurocognitive sequela of burn injury in the elderly[J].J Clin Neurosci,2019,59:1-5.DOI: 10.1016/j.jocn.2018.10.089. [18] NunesPT,KippBT,ReitzNL,et al.Aging with alcohol-related brain damage: critical brain circuits associated with cognitive dysfunction[J].Int Rev Neurobiol,2019,148:101-168.DOI: 10.1016/bs.irn.2019.09.002. [19] WangCM,ChenWC,ZhangY,et al.Update on the mechanism and treatment of sevoflurane-induced postoperative cognitive dysfunction[J].Front Aging Neurosci,2021,13:702231.DOI: 10.3389/fnagi.2021.702231. [20] KotekarN,ShenkarA,NagarajR.Postoperative cognitive dysfunction - current preventive strategies[J].Clin Interv Aging,2018,13:2267-2273.DOI: 10.2147/CIA.S133896. [21] VidermanD,NabidollayevaF,AubakirovaM,et al.Postoperative delirium and cognitive dysfunction after general and regional anesthesia: a systematic review and meta-analysis[J].J Clin Med,2023,12(10):3549.DOI: 10.3390/jcm12103549. [22] GuilloryAN,ClaytonRP,HerndonDN,et al.Cardiovascular dysfunction following burn injury: what we have learned from rat and mouse models[J].Int J Mol Sci,2016,17(1):53.DOI: 10.3390/ijms17010053. [23] SharmaV,SinghTG,KaurA,et al.Brain-derived neurotrophic factor: a novel dynamically regulated therapeutic modulator in neurological disorders[J].Neurochem Res,2023,48(2):317-339.DOI: 10.1007/s11064-022-03755-1. [24] KimEJ,PellmanB,KimJJ.Stress effects on the hippocampus: a critical review[J].Learn Mem,2015,22(9):411-416.DOI: 10.1101/lm.037291.114. [25] JeschkeMG,van BaarME,ChoudhryMA,et al.Burn injury[J].Nat Rev Dis Primers,2020,6(1):11.DOI: 10.1038/s41572-020-0145-5. [26] NielsonCB,DuethmanNC,HowardJM,et al.Burns: pathophysiology of systemic complications and current management[J].J Burn Care Res,2017,38(1):e469-e481.DOI: 10.1097/BCR.0000000000000355. [27] SwannK,BergerJ,SpragueSM,et al.Peripheral thermal injury causes blood-brain barrier dysfunction and matrix metalloproteinase (MMP) expression in rat[J].Brain Res,2007,1129(1):26-33.DOI: 10.1016/j.brainres.2006.10.061. [28] BlearsE,SommerhalderC,Toliver-KinskyT,et al.Current problems in burn immunology[J].Curr Probl Surg,2020,57(6):100779.DOI: 10.1016/j.cpsurg.2020.100779. [29] KraftR,HerndonDN,FinnertyCC,et al.Predictive value of IL-8 for sepsis and severe infections after burn injury: a clinical study[J].Shock,2015,43(3):222-227.DOI: 10.1097/SHK.0000000000000294. [30] ZhangQH,HaoJW,LiGL,et al.Proinflammatory switch from Gαs to Gαi signaling by glucagon-like peptide-1 receptor in murine splenic monocyte following burn injury[J].Inflamm Res,2018,67(2):157-168.DOI: 10.1007/s00011-017-1104-9. [31] JeschkeMG.Postburn hypermetabolism: past, present, and future[J].J Burn Care Res,2016,37(2):86-96.DOI: 10.1097/BCR.0000000000000265. [32] Moins-TeisserencH,CordeiroDJ,AudigierV,et al.Severe altered immune status after burn injury is associated with bacterial infection and septic shock[J].Front Immunol,2021,12:586195.DOI: 10.3389/fimmu.2021.586195. [33] CharoIF,RansohoffRM.The many roles of chemokines and chemokine receptors in inflammation[J].N Engl J Med,2006,354(6):610-621.DOI: 10.1056/NEJMra052723. [34] PeresheinAV,KuznetsovaSV,ShevantaevaON.On the nonspecific resistance in burn injury: pathophysiological aspects (review)[J].Sovrem Tekhnologii Med,2021,12(3):84-93.DOI: 10.17691/stm2020.12.3.11. [35] SchwachaMG.Macrophages and post-burn immune dysfunction[J].Burns,2003,29(1):1-14.DOI: 10.1016/s0305-4179(02)00187-0. [36] VanderZwaagJ,HalvorsonT,DolhanK,et al.The missing piece? A case for microglia's prominent role in the therapeutic action of anesthetics, ketamine, and psychedelics[J].Neurochem Res,2023,48(4):1129-1166.DOI: 10.1007/s11064-022-03772-0. [37] LinD,SunY,WangY,et al.Transforming growth factor β1 ameliorates microglial activation in perioperative neurocognitive disorders[J/OL].Neurochem Res,2023(2023-07-20)[2023-07-23].https://pubmed.ncbi.nlm.nih.gov/37470907/.DOI:10.1007/s11064-023-03994-w. [published online ahead of print]. [38] ZhangS,ShenL,JiaoB.Cognitive dysfunction in repeat expansion diseases: a review[J].Front Aging Neurosci,2022,14:841711.DOI: 10.3389/fnagi.2022.841711. [39] FondeurJ,Escudero MendezL,SrinivasanM,et al.Dexmedetomidine in prevention of postoperative delirium: a systematic review[J].Cureus,2022,14(6):e25639.DOI: 10.7759/cureus.25639. [40] NaylorR,SpectorA,FisherE,et al.Experiences of cognitive stimulation therapy (CST) in Brazil: a qualitative study of people with dementia and their caregivers[J].Aging Ment Health,2023:1-6.DOI: 10.1080/13607863.2023.2231376. [41] DunneRA,AarslandD,O'BrienJT,et al.Mild cognitive impairment: the Manchester consensus[J].Age Ageing,2021,50(1):72-80.DOI: 10.1093/ageing/afaa228. [42] van LoeyNE,van BeeckEF,FaberBW,et al.Health-related quality of life after burns: a prospective multicenter cohort study with 18 months follow-up[J].J Trauma Acute Care Surg,2012,72(2):513-520.DOI: 10.1097/ta.0b013e3182199072.
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