术前抑郁和焦虑对心脏手术术后认知功能的影响

Impacts of preoperative depression and anxiety on postoperative cognitive function

目的探讨紧张和焦虑对体外循环心脏手术患者术后认知功能的影响。方法100例心脏手术病人术前1d用汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)、简易智能测试量表(MMSE)、数字广度对病人进行测试。术后7d分别用MMSE、数字广度进行神经心理学测试,术后MMSE结果低于术前一个标准差则视为术后认知障碍(POCD)。结果术前焦虑、抑郁以及同时发生焦虑和抑郁的阳性率分别为30%、50%和10%。术后7天POCD的发生率为50%。女性病人焦虑得分为(7.2±4.0),T(97)=2.98,P<0.05,明显高于男性病人(4.5±3.3),T(97)=3.41(P<0.01)。女性患者的抑郁得分为(6.5±3.6),明显高于男性病人(4.2±3.4),T(97)=2.98(P<0.01)。术前焦虑与MMSE、数字广度的Pearson's相关系数分别为-0.50(P=0.2),-0.20(P=0.1),P>0.05,无统计学意义。术前抑郁与MMSE的Pearson's相关系数为-0.61(P=0.01),术前抑郁与数字广度的Pearson's相关系数为-0.72(P=0.03),P<0.05。结论术前抑郁的病人术后容易发生POCD;女性病人相对于男性,更容易出现POCD;而术前焦虑对POCD没有重要的影响。

[ Objective] To study the effects of preoperative anxiety and depression on postoperative cognitive function of patients who undergoing selective cardiac surgery. [Method] 100 patients who were scheduled for cardiac surgery were investigated by using Hamilton Anxiety Scale （HAMA） and Hamilton Depression Scale （HAMD） and mini-mental state exam （MMSE）. The patients were tested in the 7th day postoperative by MMSE and digital span. It could be defined postoperative cognitive dysfunction （POCD） if the MMSE score decreased 1 SD （standard deviation）. [Results] The positive rates of anxiety, depression, and both anxiety and depression were 30%, 50%, and 10% respectively. The anxiety score of the female patients was （7.2±4.0）, significantly higher than that of the male patients [（4.5±3.3）, T（97） = 3.41, P 〈0.01]. The depression score of the female patients was （6.5±3.6）, significandy higher than that of the male patients [（4.2±3.4）, T（97） = 2.98, P 〈0.01]. The Pearson＇s correlation between preoperative anxiety and postoperative MMSE and digital seore is -0.50（P =0.2）, -0.20（P =0.1）, respectively, P 〉 0.05. It has no statistical significance. The Pearson＇s correlation between preoperative depression and postoperative MMSE and digital score is -0.61 （P =0.01）, -0.72 （P =0.03）, respectively, P 〈0.05. [Conclusion] Female patients tend to have postoperative dysfunction compared with male patients. Preoperative depression patients are more likely to have postoperative dysfunction. The anxiety score has no significant influence on postoperative cognitive dysfunction.