ACS患者冠状动脉支架植入围手术期继发认知功能障碍的影响性研究

The correlation between revascularization factors and postoperative cognitive dysfunction with acute coronary syndromes patients

目的:探讨急性冠状动脉综合征(ACS)患者行冠状动脉支架植入术各项因素对其围手术期继发认知功能障碍(POCD)的影响。方法:前瞻性、连续性纳入我院于2014-06-19-2015-09-14期间收治的ACS患者为研究对象,所有患者均接受再血管化治疗。登记纳入患者的一般情况、现病史、既往史、家族史、合并情况、手术方式、病变程度、术后情况、病区环境等信息,将其设定为术后继发POCD的潜在影响因素。观察所有患者术后3d内是否出现继发POCD事件。以患者是否继发POCD为因变量,上述各项因素为自变量,采用单因素和多因素Logistic回归分析研究ACS患者再血管化治疗围手术期各项影响因素与继发POCD的关联性。结果:经纳入、排除标准,共纳入119例急性ACS行再血管化治疗手术的患者,其中39例患者继发POCD。经研究发现6h内开通血管、只开通罪犯血管、CK-MB峰值回落时间提前回落为独立保护因素(P<0.05);合并心源性休克、对暴露躯体感到羞耻、夜间医疗操作强光刺激为独立危险因素(P<0.05)。结论:对于具备本研究探明影响因素的患者,临床医生应予以充分警惕,从而做到尽早发现、尽早干预,有效改善患者的预后。

Objective：To investigate the correlation between revascularization factors and postoperative cognitive dysfunction（POCD）with acute coronary syndromes（ACS）patients.Method：Patients in our hospital with ACS between July/19th/2014 to September/14th/2015 undergoing revascularization were selected for this study.Registration data of the patients included the general situation,present history,past history,family history,merger cases,surgical approach,severity,postoperative conditions,ward environment and other information,which were set as the potential impact o factors for POCD.All patients were observed whether POCD happened 3days after revascularization.POCD was set as a dependent variable,and the above factors as independent variables,univariate and multivariate logistic regression analysis were used to detect the correlation between revascularization factors and postoperative cognitive dysfunction with acute coronary syndromes patients.Result：According to the inclusion and exclusion criteria,119 cases of patients with acute ACS undergoing revascularization surgery were selected,in which 39 patients had secondary POCD.The study found that revascularization in 6hours,culprit artery only,CKMB peak fall down ahead of time were independent protective factors（P〈0.05）;cardiogenic shock,shame for body exposure,light stimulation in medical procedures at night.were independent risk factors（P〈0.05）.Conclusion：Clinicians should pay attention to the patients with the potential impact o factors for POCD above,thereby leading to early detection,early intervention,and improve the prognosis of patients.