眼球运动检查在老年心脏病病人术后神经功能评估中的应用

Application of eye movement test in the assessment of central nervous system dysfunction after cardiac surgery in elderly patients

目的 探讨反向眼球扫视运动检查 (antisaccadiceyemovementtest,ASEM)在老年心脏病术后中枢神经系统功能障碍评估中的应用价值。方法 根据心脏病术后中枢神经系统功能障碍的程度 ,将 5 90例择期心脏病手术术后病人 (年龄≥ 6 0岁 )分为 3组 :Ⅰ组术后合并脑血管病、脑病等并伴有神经系统局灶体征 ;Ⅱ组术后仅表现迟钝、定向力差、谵妄、激惹和抽搐等神经系统症状 ;Ⅲ组术后无神经系统症状和体征。全部病人术后进行ASEM和简易精神状态量表 (mini mentalstateexamination ,MMSE)检查。结果 Ⅰ组和Ⅱ组ASEM不能完成率明显高于Ⅲ组 (P <0 .0 1) ,Ⅰ组和Ⅱ组ASEM全部完成率明显低于Ⅲ组 (P <0 .0 1)。ASEM检查完成分数与MMSE分数密切相关 (r =0 .6 6 ,P <0 .0 1)。结论 ASEM检查不仅能反映老年病人心脏外科术后神经功能障碍的程度 ,而且也可反映其术后高级认知功能障碍的程度。

Objective To evaluate the antisaccadic eye movement test (ASEM) in the assessment of central nervous system dysfunction after cardiac surgery in elderly patients.Methods 590 patients (≥60 years of age) who had undergone cardiac surgery were subjected to the ASEM test,the Mini-Mental State Examination (MMSE) and neurological examination after the operation.They were divided into three groups.In groupⅠ,patients had focal neurologic sign due to stroke or hypoxic encephalopathy.In groupⅡ,patients only had neurologic symptoms such as confusion,disorientation,delirium,agitation or nonmetabolic seizure without evidence of focal injury signs.In group Ⅲ,patients had no neurologic signs and symptoms.Results In groupsⅠand Ⅱ,73.9% (17/23) patients and 57.9% (33/57) patients had absent (0/10 trials) ASEM performance,while only 7.3% (37/510) patients had absent ASEM performance in group Ⅲ (P<0.01).46.7% (238/510) patients in group Ⅲ had intact (10/10 trials) performance as compared with 4.3% (1/23) patients in groupⅠand 12.3% (7/57) in groupⅡ(P<0.01).ASEM score correlated with MMSE score (r=0.66,P< 0.01). Conclusion After cardiac surgery,the ASEM test is of value in the assessment of neurologic and higher cortical dysfunction in elderly patients.