非体外循环冠状动脉旁路移植术后早期认知功能障碍的临床研究

Clinical Study on Postoperative Cognitive Dysfunction After Off-pump Coronary Artery Bypass Grafting

目的探讨非体外循环冠状动脉旁路移植术(OPCABG)术后早期认知功能障碍(POCD)的危险因素。方法收集我院2017年10月-2020年10月行OPCABG的134例患者作为研究对象,根据术后是否出现POCD将其分为POCD组(n=61)和非POCD组(n=73)。分析两组患者OPCABG术后POCD的危险因素,并进行单因素以及多因素Logistic回归分析。结果134例患者中61例术后发生POCD,发生率为45.52%。POCD组糖尿病、脑血管病史、颈动脉重度狭窄及闭塞发生率及住院时间高于非POCD组,差异有统计学意义(P<0.05);两组患者年龄、性别、学历、吸烟、饮酒、高脂血症、高血压、手术时间、心房颤动发生率及呼吸机辅助时间>24 h比率比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,糖尿病、脑血管病史、颈动脉重度狭窄及闭塞是POCD的独立危险因素(P<0.05)。结论糖尿病、脑血管病史、颈动脉重度狭窄及闭塞是POCD的独立危险因素,因此术前应对患者是否有脑血管病史、颈动脉重度狭窄及闭塞进行早期筛查,控制患者血糖,以减少POCD的发生。

Objective To investigate the risk factors of postoperative cognitive dysfunction(POCD)after off-pump coronary artery bypass grafting(OPCABG)surgery.Methods A total of 134 patients who underwent OPCABG in our hospital from October 2017 to October 2020 were collected as the study subjects.They were divided into POCD group(n=61)and non-POCD group(n=73)according to whether POCD occurred after operation.The risk factors of POCD after OPCABG in the two groups were analyzed,and the univariate and multivariate logistic regression analysis was performed.Results POCD occurred in 61 of 134 patients after operation,with the incidence of 45.52%.The incidence of diabetes,cerebrovascular disease history,severe carotid stenosis and occlusion and hospitalization time in the POCD group were higher than those in the non-POCD group,and the difference was statistically significant(P<0.05);there was no significant difference in age,gender,educational background,smoking,drinking,hyperlipidemia,hypertension,operation time,incidence of atrial fibrillation and ventilator-assisted time>24 h ratio between the two groups(P>0.05).Multivariate Logistic regression analysis showed that diabetes,history of cerebrovascular disease,severe carotid stenosis and occlusion were independent risk factors for POCD(P<0.05).Conclusion Diabetes,cerebrovascular history,severe carotid stenosis and occlusion are independent risk factors for POCD,Therefore,the patients should have a history of cerebrovascular disease and carotid artery stenosis and occlusion early screening,controlling blood sugar,so as to reduce the occurrence of POCD.