老年非体外循环下冠状动脉旁路移植术后认知功能障碍的临床研究

Postoperative cognitive dysfunction in elderly patients after off-pump coronary artery bypass grafting

目的：探讨老年非体外循环下冠状动脉旁路移植术（OPCABG）术后认知功能障碍（POCD）的发病情况及其危险因素，并分析320排CT评估的脑血管功能情况与POCD的相关性。方法选择行OPCABG的老年患者213例，并根据是否出现POCD分为病例组28例和对照组185例，行320排CT检查、评估脑血管功能、神经系统和认知功能；术后14 d再次进行评估，对比分析POCD的危险因素和CT脑灌注成像各参数与 POCD的关系。结果与对照组比较，病例组既往脑血管病、糖尿病、头颅CT 血管造影重度狭窄和CT 脑灌注异常均明显升高（ P＜0.01）。多因素logistic回归分析显示，既往脑血管病史（OR＝1．837，95％ CI：1．075～3．141，P＝0．026）和脑灌注异常（OR＝3．224，95％ CI：2．073～5．013，P＝0．000）为POCD的独立危险因素。结论早期发现脑血管狭窄、脑灌注不良以及维持血糖平稳对于降低POCD的发生有重要意义。

Objective To study the postoperative cognitive dysfunction （POCD） in elderly patients after off‐pump coronary artery bypass grafting （OPCABG）and its risk factors ,and the association between cerebrovascular function assayed by 320 dynamic volume CT and POCD .Methods Two hundred and thirteen elderly patients selected for OPCABG were divided into patients group （n=28） and control group （n=185） .The patients underwent 320 dynamic volume CT to show their cerebrovascular ,neurological and cognitive functions .The patients were assessed on day 14 after operation .The risk factors for POCD and the association between CT perfusion imaging parame‐ters and POCD w ere comparatively analyzed .Results T he incidence of cerebrovascular disease , diabetes mellitus ,CTA‐detected severe cerebrovascular stenosis and abnormal cerebral pufusion was significantly higher in patients group than in control group （P〈 0 .01） .Logistic regression analysis showed that cerebrovascular disease history and abnormal cerebral pufusion were the in‐dependent risk factors for POCD （OR= 1 .837 ,95% CI：1 .075 -3 .141 ,P= 0 .026 ;OR= 3 .224 , 95% CI：2 .073-5 .013 ,P=0 .000） .Conclusion Early detection of abnormal cerebrovascular ste‐nosis ,poor cerebral perfusion and maintainence of stable blood glucose play an important role in reducing the incidence of POCD in elderly patients after OPCABG .