反向眼球扫视运动检查在心脏外科术后中枢神经功能评估中的应用

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

目的 探讨反向眼球扫视运动检查（Antisaccadic eye movement test,ASEM）在心脏外科术后中枢神经系统功能障碍评估中的应用价值。方法 根据术后中枢神经系统功能障碍,将921例心脏外科术后病人分为三组;I组术后合并脑血管病、脑病等神经系统局灶体征;Ⅱ组术后仅表现迟钝、定向力差、谵妄、激惹、抽搐等神经系统症状;Ⅲ组术后神经系统既无症状也无体征。全部病人均进行术后 ASEM和简短精神状态量表（Mini-mental state examination,MMSE）检查。结果 ASEM检查完成分数与MMSE分数密切相关（γ=0.67,P<0.01）。I组 ASEM不能完成率（ASEM分数=0）明显高于Ⅱ组（P<0.05）,I组和Ⅱ组ASEM不能完成率明显高于Ⅲ组（P<0.01）,Ⅲ组ASEM全部完成率（ASEM分数=10）明显高于I组和Ⅱ组（P<0.01）。结论ASEM检查不仅能反映心脏外科术后神经功能障碍,而且也可反映术后高级认知功能障碍。

Objective To evaluate the antisaccadic eye movement(ASEM) test in the assessment of central nervous system dysfunction after cardiac surgery. Methods 921 patients(571 male, 350 female) aged 27-89 years, undergoing elective cardiac surgery were subjected to ASEM test, mini-mental state examination (MMSE) and neurological examination on the 3rd-4th postoperative day. 765 patients received coronary artery bypass(CAB) ; 68 patients valve replacement(VR) and 88 patients CAB+ VR. Those who had neurological deficit or mental disease before operation and those who were hard of hearing were excluded. The patients were divided into three groups: in group Ⅰ patients had focal neurologic deficits due to cerebrovascular or hypoxic encephalopathy( n= 25 ) ; in group Ⅱ patients had only neurologic symptoms such as confusion, disorientation, agitation or non-metabolic seizure without evidence of focal injury; in group Ⅱ patients had no neurologic signs and symptoms. Postoperative CNS functional disturbances were evaluated by neurologists and neurological focal deficits were confirmed by CT, MRI and EEG. Results The ASEM score correlated closely with MMSE score(γ = 0.67,P<0.01). The percentage of the patients with bad ASEM performance (ASEM score = 0) in group I was significantly higher than that in group Ⅱ(P<0.05) . The percentage of the patients with bad ASEM performance in group Ⅰ and Ⅱ were also higher than that in group Ⅲ(P<0.01). The percentage of the patients with perfect performance (ASEM score= 10) in group Ⅲ was significantly higher than that in group Ⅰ and Ⅱ (P<0.05 or 0.01) . Conclusions The ASEM is highly correlated with both neurologic and cognitive deficits and could be of value in the assessment of the cognitive state of the patients after cardiac surgery.