心脏术后患者认知功能障碍危险因素的Meta分析

A meta-analysis of risk factors of postoperative cognitive dysfunction after cardiac surgery

目的通过Meta分析明确心脏术后认知功能障碍(postoperative cognitive dysfunction,POCD)的危险因素。方法通过进行文献质量评价,应用Rev Man 5.3分析软件进行敏感性和异质性分析,并采用固定效应或随机效应模型计算合并后的综合效应。结果 19篇文献符合纳入标准,POCD组1104例,非POCD组2800例,共纳入心脏POCD危险因素28个。经Meta分析,年龄、女性、受教育年数、BMI、糖尿病、脑卒中史、术前抑郁、心力衰竭、左室射血分数<30%、头颅CT脑血管重度狭窄、机械通气时间、ICU时间、血肌酐水平异常具有综合效应,为心脏POCD的独立预测因素。结论高龄、缺氧、机械通气时间延长,以及留置ICU时间延长是心脏POCD的独立预测因素,而女性、心力衰竭、麻醉用药及术前抑郁对心脏术后认知功能的预测价值,证据尚不充分。

Objective To identify the risk factors of postoperative cognitive dysfunction after cardiac surgery by meta-analysis. Methods Quality of the studies was assessed in terms of study design,definitions of main variables, statistics and bias control. Analysis of sensitivity and heterogeneity was performed and cumulative effects were cal- culated using either fixed or random effects models by RevMan 5.3. Results Nineteen studies were recruited,in- cluding 1104 cases of POCD and 2800 cases of non-POCD. Twenty-eight risk factors of postoperative cognitive dysfunction after cardiac surgery were involved,among which age,women,year of education,body mass index,dia- betes mellitus,stroke history,preoperative depression,controlled heart failure,left ventricular ejection fraction 〈30%, head CT cerebrovascular severe stenosis,mechanical ventilation time,ICU time,serum creatinine level were indepen- dent predictors of postoperative cognitive dysfunction. Conclusion Patients with advanced age,hypoxia,prolonged mechanical ventilation and longer stay in ICU are at an increased risk of developing postoperative cognitive dys- function,while the effects of female,heart failure,narcotic drugs and preoperative depression are still inconclusive.