体外循环术后早期血液流变学变化与术后谵妄的关系

An analysis of relationship in hemorheological changes after cardiopulmonary bypass early with postoperative delirium

目的研究体外循环(CPB)术后早期血液流变学变化并初步分析其与术后谵妄(POD)的关系。方法选择2010年6月至2011年6月在简阳市人民医院择期行CPB下单瓣膜置换术的风湿性瓣膜性心脏患者30例,采用静吸复合全身麻醉,浅低温高流量CPB。分别在麻醉输液实施前(T0),CPB毕(T1),CPB后1d(T2),CPB后2d(T3),CPB后3d(T4)经动脉各采血5mL,检测中切全血黏度(Mηb)、血浆黏度(ηP)。并于T2～T4用重症监护病房(ICU)精神错乱评估量表(CAM-ICU)测定患者的神经精神状态。结果27例患者纳入统计分析,其中9例患者在术后1～3d出现急性精神障碍,故以CAM-ICU分为POD组(9例)和未发生谵妄(NPOD)组(18例)。两组患者人口学资料差异无统计学意义(P>0.05)。POD组在T2～T4时间点Mηb水平均比NPOD组高,差异有统计学意义(P<0.05),而ηP水平在T1时间点比NPOD组高,差异有统计学意义(P<0.05)。结论 CPB后出现谵妄的患者表现出血液流变学的早期恶化,应加强对血液流变学的监测与治疗。

Objective To study hemorheological changes after the cardiopulmonary bypass（CPB） early and preliminary analysis the relationship with postoperative delirium（POD）. Methods 30 patients who had rheumatic valvular heart disease from June 2010 to June 2011 in our hospital for elective single-valve replacement surgery under CPB were enrolled. All patients received the same intravenous inhalation anesthesia,mild hypothermia and high-flow CPB. Blood samples（5 mL） were from artery taken at： T0 （before the infusion and induction of anesthesia） ,T1（after CPB） ;T2（1 day after CPB） ,T3（2 day after CPB） and T4（3 day after CPB） for the hemorheological measurements. After CPB 1,2,3 days, the CAM-ICU（Confusion Assessment Method for the ICU Patients） were determination in patients with neuropsychiatric status. Results In 27 cases were included in the statistical analysis. 9 patients in one to three days after CPB had acute mental disorders,it was divided into POD group and NPOD group without POD （18 cases） according to CAM-ICU. The demographic datum of two groups had no significant difference（P〉0.05）. The Mηb, the POD group in T2 toT4 time points were higher than NPOD group（P〈0.05）, while -ηP was higher in the T1 in POD group than NPOD group（P〈0.05）. Conclusion Early hemorheological deterioration may be associated with postoperative delirium after cardiopulmonary bypass, the monitoring and treatment on blood theology should be strengthened.