心脏瓣膜术后早期认知功能障碍的相关危险因素分析

Risk factors for early cognitive dysfunction after cardiac valve surgery

目的术后认知功能障碍(POCD)是心脏手术常见的并发症,严重影响患者的预后。文中旨在探讨心脏瓣膜手术早期POCD的相关危险因素及早期POCD与血清S100B蛋白水平的相关性。方法选取2015年6月到2016年8月南昌大学第一附属医院心胸外科行二尖瓣置换联合三尖瓣直视成形手术的80例患者,分别于术前第1天、术后第5天对入选患者进行神经功能评定,按患者是否发生POCD分为POCD组和非POCD组。记录2组患者年龄、性别、教育程度、New Euroscore II评分、本次入院术前NYHA心功能分级及左室射血分数等指标。分别于手术当天早上8点、体外循环结束后30 min、24 h、48 h、72 h采集患者静脉血,采用ELISA法测定S100B蛋白水平。采用单因素分析及logistic回归分析早期POCD的危险因素。结果 POCD组患者20例,非POCD组患者60例。高血糖[OR=6.038,95%CI:1.202~30.337]、手术时间[OR=6.423,95%CI:1.276~32.332]、AST值大于正常值2倍[OR=12.878,95%CI:2.289~72.445]是早期POCD的独立危险因素。与POCD组体外循环结束后30 min、24 h的S100B蛋白浓度[(2.4±0.4)、(2.1±0.3)μg/L]比较,POCD组体外循环结束后72 h明显降低[(1.7±0.4)μg/L];与非POCD组体外循环结束后48 h S100B蛋白浓度[(1.5±0.4)μg/L]比较,非POCD组体外循环结束后72 h[(1.4±0.4)μg/L]明显降低(P<0.05)。结论手术时间长,围术期高血糖、AST值大于正常值2倍可预示早期POCD的发生;血清S100B蛋白可作为早期POCD的重要标志物。

Objective Postoperative cognitive dysfunction（ POCD） is a common complication of cardiac surgery,which seriously affects the prognosis of the patient. This study aimed to explore the risk factors for early POCD in patients undergoing cardiac valve surgery and the correlation between early POCD and the serum S100 B protein level. Methods Eighty patients underwent mitral valve replacement surgery in combination with tricuspid plasty. At 1 day before and 5 days after surgery,we assessed the cognitive function of the patients and divided them into a POCD and a non-POCD group. We obtained such data as the age,sex,education,New Euro SCORE Ⅱ,and preoperative NYHA cardiac function grades and left ventricle ejection fraction（ LVEF） of the patients,collected the venous blood to determine serum S100 B protein concentration by ELISA,and analyzed the independent risk factors of early POCD using single-factor and binary logistic regression analyses. Results POCD was found in 20（ 25%） of the patients,,Logistic regression analysis showed the independent risk factors for early POCD to be hyperglycemia（ OR = 6.038,95% CI： 1. 202-30. 337）,operation time（ OR= 6.423,95% CI： 1.276-32.332）,and aspartate aminotransferase（ AST,2 times higher than normal）（ OR = 12.878,95% CI： 2.289-72.445）. The serum S100 B protein concentrations in the POCD group were（ 1.9±0.3） μg/L and（ 1.7± 0. 4） μg/L at 48 and 72 hours after cardiopulmonary bypass,significantly lower than（ 2.4±0.4） μg/L and（ 2.1±0.3） μg/L at 30 minutes and 24 hours（ P〈0.05）,and so was it in the non-POCD group at 72 than at 48 hours postoperatively（ [1.4±0.4]） vs [1.5±0.4] μg/L,P〈0.05）. Conclusion Long operation time,perioperative hyperglycemia and high AST are independent predictors and the serum S100 B protein level is a significant marker of early POCD.